M112Remark Code (RARC)Active
M112 Remark Code - DMEPOS Competitive Bidding Payment
The M112 remark code indicates that reimbursement for the billed item is determined by the single payment amount established under the DMEPOS Competitive Bidding Program, specific to the patient's residential area. This remark supplements an adjustment already explained by a Claim Adjustment Reason Code, clarifying the basis for the payment amount on the claim.
How It Relates to the Denial
The M112 remark typically accompanies adjustment reason codes related to payments for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). Together, these codes signal that the payment has been adjusted according to competitive bidding regulations for the patient's location.
Common Scenarios
1A claim was submitted for a power wheelchair for a patient living in a competitive bidding area, and the payment received was lower than expected.
→ The M112 remark indicates that the reimbursement amount is based on the competitive bidding program's set rate for that specific region, which may differ from standard pricing.
2A home oxygen therapy claim was processed, and the remittance showed a payment adjustment with the M112 remark attached.
→ This remark explains that the payment adjustment is due to the single payment amount determined by the DMEPOS Competitive Bidding Program, reflecting the local pricing structure.
3A claim for a hospital bed was billed, and the remittance includes an adjustment reason code along with the M112 remark.
→ The M112 remark clarifies that the reimbursement for the hospital bed is subject to the competitive bidding rates applicable to the area where the patient resides.
What to Do
- Review the adjustment reason code to understand the initial payment adjustment context.
- Confirm that the billed item is covered under the DMEPOS Competitive Bidding Program for the patient's area.
- Ensure that the billed amount aligns with the established single payment amount for the patient's location.
What to Check
- The patient's residential address to verify if it falls within a competitive bidding area.
- The DMEPOS pricing list to confirm the single payment amount for the specific item.
- The claim details to ensure the correct item was billed and is eligible for competitive bidding reimbursement.