We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
Code type
RARC (Remark)
Category
Non-Covered Service
Common CARC pairings
RARCs like M55 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC M55 is most often paired with.
| CARC | Meaning |
|---|---|
| 96 | Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
See the full resolution workflow for RARC M55
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 quirks.
Open in EDI Lab