M80Remark Code (RARC)Active
M80 Remark Code - Not Covered When Performed Together
The M80 remark code indicates that the service in question is not covered because it was performed on the same date as a previously processed service for the patient. This means the payer has determined that the billed service overlaps with another service that was already adjudicated, leading to a denial for coverage on this occasion.
How It Relates to the Denial
The M80 remark code typically accompanies a Claim Adjustment Reason Code (CARC) that explains the adjustment related to coverage denials. Together, they signal that the payer considers the services to be part of the same session and therefore not separately billable.
Common Scenarios
1A provider bills for an office visit and a diagnostic test on the same day for a patient. The remittance shows an adjustment for the diagnostic test with the M80 remark code.
→ In this case, the M80 remark signifies that the diagnostic test is not covered because it was performed during the same session as the office visit, which has already been processed.
2A claim is submitted for a surgical procedure and a follow-up imaging study done on the same date. The remittance returns with a denial for the imaging study accompanied by the M80 remark code.
→ Here, the M80 remark indicates that the imaging study is not covered since it occurred on the same date as the surgical procedure, which was already billed and processed.
3A patient receives physical therapy and a follow-up evaluation on the same day. The payer denies the follow-up evaluation with the M80 remark code present on the remittance advice.
→ The M80 remark in this scenario indicates that the payer does not cover the follow-up evaluation because it was performed during the same session as the physical therapy, which has been previously processed.
What to Do
- Review the details of the previously processed service that is causing the denial for the current claim.
- If applicable, consider whether the services can be restructured and billed separately on different dates.
What to Check
- The original claim submission to verify the dates of service.
- The remittance advice to identify the associated Claim Adjustment Reason Code.
- Patient records to confirm the services rendered on the same date.