M104Remark Code (RARC)Active
M104 Remark Code - Break in Therapy Explained
The M104 remark code indicates that the information provided supports a break in therapy for the rental of durable medical equipment. This implies that a new capped rental period will commence upon the delivery of the equipment, aligning with the maximum approved amount under the fee schedule for the service rendered.
How It Relates to the Denial
The M104 remark typically accompanies a claim adjustment reason code that reflects an adjustment related to rental equipment and therapy breaks. This combination signals that the claim has been reviewed and the adjustment aligns with established guidelines regarding rental periods.
Common Scenarios
1A patient has been receiving a rented wheelchair but has had a break in therapy for several months. The provider submits a claim for a new rental period once therapy resumes.
→ In this case, the M104 remark indicates that the payer acknowledges the break in therapy and confirms that a new capped rental period will start with the delivery of the wheelchair, following fee schedule guidelines.
2A provider bills for a capped rental of a nebulizer after a patient's therapy was paused for an extended period. The remittance shows an adjustment with the M104 remark.
→ Here, the M104 remark clarifies that the payer supports the initiation of a new capped rental period due to the documented break in therapy, adhering to the maximum fee schedule allowance.
3A claim for a rental period of a CPAP machine is submitted after a hiatus in therapy. The remittance includes an adjustment along with the M104 remark code.
→ The M104 remark indicates the payer's acceptance of the break in therapy, confirming that a new capped rental period will begin with the delivery of the CPAP machine, consistent with the fee schedule.
What to Do
- Ensure that the documentation of the break in therapy is complete and clearly supports the new rental period.
- Verify that the rental equipment delivery date is accurately reflected in the claim submission.
- Confirm that the billed amount aligns with the maximum approved fee schedule for the rental item.
What to Check
- The patient's therapy records to validate the documented break in therapy.
- The rental agreement and delivery documentation for the equipment.
- The fee schedule to ensure compliance with the maximum allowable amount for the service.