M90Remark Code (RARC)Active
M90 Remark Code - Not Covered More Than Once
The M90 remark code indicates that a service was billed that is not covered more than once in a 12-month period. This means that the payer has determined that the service in question has already been provided and is therefore not eligible for reimbursement again within the specified timeframe.
How It Relates to the Denial
The M90 remark code typically accompanies a Claim Adjustment Reason Code that indicates a denial based on frequency limitations. Together, they signal that the billed service has exceeded the allowed frequency for coverage within a year.
Common Scenarios
1A provider bills for a specific diagnostic test that is covered once yearly. The remittance shows an adjustment for the test with a reason code indicating it was already billed.
→ The M90 remark code clarifies that the denial is due to the test not being covered more than once in a 12-month period, as the patient has already received it.
2An office visit is submitted for a patient who had a similar visit within the last 11 months. The remittance shows an adjustment denying the claim for frequency.
→ The M90 remark code indicates that the visit is not covered because it exceeds the maximum number of allowed visits within the specified timeframe.
3A patient receives a therapeutic procedure that is limited to once per year. The claim is submitted, but the remittance shows an adjustment indicating the procedure was not covered.
→ The M90 remark code points out that the procedure was already performed within the previous 12 months, hence the denial.
What to Do
- Review the patient's service history to confirm if the service was previously performed within the last 12 months.
- Verify the service frequency limitations in the payer's policy documentation to understand coverage rules.
- If the service was indeed performed within the allowed timeframe, consider appealing the decision with supporting documentation.
What to Check
- The patient's claim history to see if the service has been billed in the last year.
- The payer's coverage policies regarding the specific service and its frequency limits.
- The accompanying reason code on the remittance advice for additional context on the denial.