M91Remark Code (RARC)Active
M91 Remark Code - Lab Procedures Billing Guidelines
The M91 remark code indicates that lab procedures requiring different CLIA certification numbers must be submitted on separate claims. This code supplements an adjustment reason code and clarifies that billing multiple procedures under one claim is not compliant with certification requirements.
How It Relates to the Denial
The M91 remark code typically accompanies adjustment reason codes related to denied lab claims. The combination signals that the payer found lab procedures on the same claim but with different CLIA certifications, leading to a need for separate submissions.
Common Scenarios
1A facility submits a claim for multiple lab tests performed on the same patient, including tests that require different CLIA certifications.
→ The M91 remark code suggests the payer expects each lab test to be billed on its own claim due to differing certification requirements.
2A provider bills a comprehensive lab panel that includes tests from labs with distinct CLIA numbers, resulting in a partial denial for some tests.
→ The M91 remark code indicates that the tests must be separated into individual claims to comply with certification regulations.
3A patient receives various lab services during a single visit, but the claim submitted includes tests from two different laboratories, each with unique CLIA numbers.
→ The M91 remark code signals that the payer requires these lab services to be billed separately to adhere to CLIA certification rules.
What to Do
- Separate the lab procedures into individual claims based on their CLIA certification numbers.
- Ensure each claim submitted includes only procedures that share the same CLIA certification.
- Review the claim submission process to confirm compliance with CLIA requirements.
What to Check
- The CLIA certification numbers for each lab procedure billed.
- The original claim submission to verify how lab procedures were grouped.
- Payer guidelines for lab billing and CLIA certification compliance.