M86 – Service Denied Because Payment Is Included in Another Service

The M86 RARC code indicates that payment for the reported service is included in the reimbursement for another service. This Remittance Advice Remark Code (RARC) provides additional information regarding the payer's reimbursement decision and is typically reported with a Claim Adjustment Reason Code (CARC).

Providers should review the associated CARC, coding guidelines, and payer reimbursement policies before taking corrective action.

Quick Facts

RARC Code
M86

Code Type
Remittance Advice Remark Code (RARC)

Category
Bundled Services

Meaning
Payment for the service is included in another reimbursed service

Common Payers
Medicare, Medicaid, and Commercial Insurance

Next Step
Review coding guidelines and determine whether the service should have been billed separately

What Does the M86 RARC Code Mean?

The M86 RARC code indicates that the payer considers the reported service bundled into another reimbursable service and therefore does not allow separate payment.

The remark code supplements the associated CARC by explaining why reimbursement was not issued separately.

Common Causes

Providers may receive the M86 RARC code when:

• Related procedures are billed separately.

• Bundling rules apply.

• NCCI edits prevent separate reimbursement.

• An appropriate modifier was not reported.

• Payer reimbursement policies consider the service inclusive.

How To Resolve the M86 RARC Code

If you receive the M86 remark code:

• Review the associated CARC.

• Verify CPT coding.

• Review NCCI edits.

• Determine whether documentation supports a modifier.

• Submit a corrected claim if appropriate.

Providers should review payer billing policies before appealing.

Common Billing Mistakes

Common issues associated with the M86 RARC code include:

• Billing bundled services separately.

• Missing appropriate modifiers.

• Misinterpreting payer reimbursement policies.

• Failing to review NCCI edits.

• Appealing bundled services without supporting documentation.

Frequently Asked Questions

Does M86 always indicate incorrect coding?

No. In many cases, the payer correctly bundles the service according to reimbursement policies.

Can a modifier resolve an M86 adjustment?

Sometimes. If documentation supports separate reimbursement, an appropriate modifier may allow payment depending on payer guidelines.

Should providers review NCCI edits?

Yes. NCCI edits often explain why services are bundled and whether separate payment is permitted.

When should providers appeal an M86 adjustment?

Appeals should generally be considered only when documentation supports separate reimbursement under payer policies.

Related RARC Codes

You may also encounter:

• M15 RARC Code

• N20 RARC Code

• N522 RARC Code

• N290 RARC Code

Quick Summary

The M86 RARC code indicates that payment for the billed service is included in another reimbursed service. Reviewing coding guidelines, NCCI edits, payer policies, and the associated CARC can help determine whether a corrected claim or appeal is appropriate.