M82Remark Code (RARC)Active
M82 Remark Code - Service Not Covered Under Age 50
The M82 remark code indicates that the billed service is not covered by the payer because the patient is under the age of 50. This remark supplements an adjustment already made by the accompanying reason code, providing additional context for the denial.
How It Relates to the Denial
Typically, M82 appears alongside reason codes that indicate a denial for services based on age restrictions. The combination signals that the patient does not meet the age criteria set forth by the payer for the provided service.
Common Scenarios
1A claim for a preventive screening was submitted for a patient who is 45 years old. The remittance response includes a reason code for age restrictions along with the M82 remark.
→ In this case, the M82 remark clarifies that the service is not covered due to the patient being under 50, reinforcing the reason for denial.
2An office visit for a specific health assessment was billed for a 48-year-old patient, but the payer denied the claim citing age-related coverage limits with the M82 remark included.
→ The M82 remark indicates that the service is not covered for the patient because they do not meet the minimum age requirement of 50 years.
3A claim for a therapeutic procedure was submitted for a patient aged 49, resulting in a denial with a reason code related to coverage limitations and the M82 remark.
→ The M82 remark signals that the claim is denied because the patient is under the age threshold of 50, which is a stipulation for coverage.
What to Do
- Review the patient's age to confirm eligibility for the billed service.
- Determine if the service can be billed again once the patient reaches the qualifying age, if applicable.
- Consider discussing alternative services that are covered for patients under 50 with the provider.
What to Check
- Verify the patient's date of birth against the claim submission date.
- Review the specific service guidelines for age restrictions in the payer's policy documentation.
- Check the accompanying reason code for additional details on the denial.