M94Remark Code (RARC)Active
M94 Remark Code - Break in Therapy Not Supported
The M94 remark code indicates that the information submitted does not justify a break in therapy for the service billed. As a result, a new capped rental period for the equipment or service will not be initiated by the payer.
How It Relates to the Denial
Typically, M94 accompanies a Claim Adjustment Reason Code that relates to rental equipment or therapy services. This combination suggests that the payer believes the criteria for a break in therapy have not been met, impacting the rental period.
Common Scenarios
1A claim for durable medical equipment (DME) was submitted for a capped rental item after a brief interruption in usage. The remittance returned with a claim adjustment reason code indicating a denial due to a lack of supporting documentation.
→ In this case, the M94 remark code clarifies that the documentation provided did not substantiate a break in therapy, which is necessary to start a new rental period for the DME.
2A patient receiving physical therapy services had a lapse in treatment, and the provider submitted a claim for continued therapy equipment rental. The remittance response included an adjustment reason code related to rental period limits.
→ Here, the M94 remark code means that the payer found the information inadequate to support re-establishing a rental period for the therapy equipment, indicating the need for continuous therapy documentation.
3A claim for a capped rental item was submitted after a patient had been discharged from therapy for a few weeks. The remittance included a denial reason code regarding therapy breaks.
→ The M94 remark code indicates that the payer did not find sufficient evidence to justify a break in therapy, thus preventing the initiation of a new rental cycle for the equipment.
What to Do
- Review the documentation submitted with the claim to ensure it supports a break in therapy if applicable.
- Consider resubmitting the claim with additional information that demonstrates the need for a new capped rental period, if warranted.
- Make sure to include any relevant therapy notes or progress reports that may justify the break in therapy.
What to Check
- The patient's therapy notes to verify the continuity of care and any documented breaks.
- The rental agreement terms for the equipment to confirm rental period rules.
- The claim adjustment reason code on the remittance to see the primary reason for the adjustment.