M60Remark Code (RARC)Active
M60 Remark Code - Missing Certificate of Medical Necessity
The M60 remark code indicates that a Certificate of Medical Necessity (CMN) is missing for the services billed. This remark supplements an adjustment made by the accompanying reason code, highlighting that the lack of this documentation is the reason for the denial or reduction in payment.
How It Relates to the Denial
Typically, the M60 remark accompanies adjustment reason codes related to documentation issues. It signals that the payer requires additional proof of medical necessity to process the claim correctly.
Common Scenarios
1A provider submits a claim for a durable medical equipment item but receives a denial with an adjustment reason code indicating insufficient documentation.
→ The M60 remark indicates that the denial is specifically due to the absence of a Certificate of Medical Necessity, which the payer needs to verify the medical necessity of the equipment.
2A claim for physical therapy services is denied, stating that the documentation is incomplete.
→ Here, the M60 remark suggests that the payer is missing the required Certificate of Medical Necessity, which is necessary for the approval of the therapy services.
3A claim for a home health service is submitted but returned with a denial indicating a lack of supporting documentation.
→ The presence of the M60 remark indicates that the payer is looking for a Certificate of Medical Necessity to support the claim for home health services.
What to Do
- Obtain a completed Certificate of Medical Necessity from the provider.
- Submit the missing CMN along with the claim for reconsideration.
- Ensure that the CMN meets the payer's requirements for documentation.
What to Check
- Verify if the Certificate of Medical Necessity was requested at the time of service.
- Review the claim documentation to ensure all necessary forms are included.
- Check the remittance advice for the accompanying reason code to confirm the adjustment context.