M89Remark Code (RARC)Active
M89 Remark Code - Not Covered More Than Once Under Age 40
The M89 remark code indicates that the billed service is not covered more than once for patients under the age of 40. This typically means that the service has been previously utilized and is therefore ineligible for additional reimbursement under the current claim.
How It Relates to the Denial
The M89 remark code usually accompanies a Claim Adjustment Reason Code that indicates a denial or reduction due to coverage limitations. This combination signals that the service has been denied based on age-related coverage restrictions.
Common Scenarios
1A provider submits a claim for a diagnostic test for a patient aged 35, which has been performed previously within the same benefit period. The remittance shows an adjustment with the reason code indicating denial due to prior service.
→ In this case, the M89 remark code clarifies that the test is not covered again for the patient under 40 years of age, reinforcing the reason for the claim adjustment.
2A patient aged 38 receives a second treatment session for a procedure that is limited to one occurrence for those under 40. The claim is returned with a denial adjustment.
→ The M89 remark code indicates that the denial is due to the patient's age and the policy's restriction on coverage for this service, confirming that it cannot be billed again.
3A claim for a preventive service is submitted for a 39-year-old patient. The remittance response shows an adjustment with a reason code for non-coverage, along with the M89 remark code.
→ The M89 remark code here explains that the preventive service is not covered more than once for someone under 40, thus supporting the denial provided by the accompanying reason code.
What to Do
- Review the patient's age to confirm eligibility for the service.
- Check the patient's prior service history to determine if the service has already been billed.
- Verify the payer's policy on coverage limitations for the service in question.
What to Check
- The patient's age at the time of service to confirm it falls under the specified limit.
- Previous claims submitted for the same service to identify if it has been billed before.
- The payer's coverage policy documents to understand limitations on service frequency.