DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
Code type
RARC (Remark)
Category
Coordination of Benefits
Common CARC pairings
RARC M11 appears with a Claim Adjustment Reason Code (CARC) on the 835 electronic remittance advice and gives more detail about the adjustment. These are the CARCs most often paired with RARC M11.
| CARC | Meaning |
|---|---|
| 109 | Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor. |
See the full resolution workflow for RARC M11
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every RARC and CARC pairing, plus payer-specific requirements.
Open in EDI Lab