M113Remark Code (RARC)Active
M113 Remark Code - DMEPOS Competitive Bidding Issue
The M113 remark code indicates that the payer's records show the patient started using the durable medical equipment or service before the current contract period for the DMEPOS Competitive Bidding Program. This suggests that the billed service may not be covered under the current contract terms due to the timing of the patient's usage.
How It Relates to the Denial
The M113 remark code typically accompanies an adjustment reason code that relates to coverage limitations based on contract periods. When seen together, they signal that the service billed may not be eligible for reimbursement due to prior usage outside the current contract terms.
Common Scenarios
1A provider submits a claim for a wheelchair rental for a patient who has been using it since last year. The remittance advises that the claim is being adjusted due to the competitive bidding program.
→ In this case, the M113 remark code indicates that the wheelchair rental is not covered under the current bidding contract because the patient began using it before the current period.
2A claim for oxygen supplies is submitted, but the payer returns an adjustment indicating prior usage. The remittance includes the M113 remark code.
→ The M113 remark code suggests that the patient was already utilizing the oxygen supplies prior to the current contract, which may affect the claim's eligibility for payment.
3A bill for a prosthetic limb is sent to the payer, but the remittance shows an adjustment with the M113 remark code.
→ This indicates that the prosthetic limb was in use before the current contract period, signaling potential issues with coverage under the current DMEPOS guidelines.
What to Do
- Review the patient's history to confirm the start date of service usage.
- Check the current contract terms for the DMEPOS Competitive Bidding Program to understand coverage limitations.
- Consider resubmitting the claim with additional documentation if the patient qualifies under a different contract provision.
What to Check
- The patient's service start date to verify usage history.
- The contract period for the DMEPOS Competitive Bidding Program.
- The claim adjustment reason code that accompanies the M113 remark code for further detail on the denial.