Reason Code 119 | Remark Codes M86

Code Description
Reason Code: 119 Benefit maximum for this time period or occurrence has been reached.
Remark Codes: M86 Service denied because payment already made for same/similar procedure within set time frame.

 

Common Reasons for Denial

  • Item has met maximum limit for this time period. Payment already made for same/similar procedure within set time frame.

Next Step

  • Review claim submitted for frequency limits or same or similar items listed in LCD and Policy Article, through Same or Similar option 2 and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need.

How to Avoid Future Denials

 

Last Updated Wed, 28 Oct 2020 21:11:18 +0000