M96Remark Code (RARC)Active
M96 Remark Code - Technical Component Billing Rules
The M96 remark code indicates that the technical component of a service provided to an inpatient must be billed by the inpatient facility. This means you must reach out to that facility for reimbursement of the technical component, while you may submit a claim for the professional component only if it hasn't been billed yet.
How It Relates to the Denial
The M96 remark code typically accompanies claim adjustment reason codes that relate to reimbursement responsibilities between facility and professional services. This combination signals that the payer is clarifying billing responsibilities for inpatient services.
Common Scenarios
1A hospital outpatient service was billed for an inpatient procedure, and the remittance shows an adjustment for the technical component.
→ The M96 remark code indicates that the technical component should have been billed by the inpatient facility, and you need to contact them for reimbursement.
2A physician billed for both the technical and professional components of a procedure performed on an inpatient, resulting in a denial for the technical component.
→ With the M96 remark code, the payer is clarifying that only the professional component can be billed by the physician, directing you to seek reimbursement for the technical component from the inpatient facility.
3A claim was submitted for an inpatient service that included both components, and the remittance states that the technical component is denied with an accompanying adjustment reason code.
→ The presence of the M96 remark code confirms that the technical component must be billed by the inpatient facility, indicating the need for a corrected claim for only the professional component.
What to Do
- Contact the inpatient facility to discuss reimbursement for the technical component.
- If the professional component has not been billed, prepare and submit a claim for it.
What to Check
- The original claim submitted for the inpatient service to confirm billed components.
- Payer guidelines regarding billing for inpatient services and component responsibilities.
- Any correspondence or documentation from the inpatient facility regarding the technical component.