Reason Code 97 | Remark Code M2

Code Description
Reason Code: 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Remark Code: M2 Not paid separately when the patient is an inpatient.

 

Common Reasons for Denial

  • Beneficiary was inpatient on date of service billed

Next Step

  • If beneficiary was not inpatient on date items were provided, a Redetermination request may be submitted with all relevant supporting documentation. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and documentation checklists prior to submitting request. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal
  • If wrong date of service was billed, suppliers may call telephone reopenings to correct it

How to Avoid Future Denials

  • Verify correct date of service and place of service is billed
  • Payment cannot be made by DME MAC for items received while a beneficiary is in a hospital stay unless equipment was delivered no more than two days prior to discharge
  • Suppliers may call Noridian Interactive Voice Response (IVR) System or use the Noridian Medicare Portal to verify if beneficiary was inpatient or not

 

Last Updated Apr 18, 2018