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M26 - Denial Journal
RARC

M26

What This Code Means

The information furnished does not substantiate the need for this level of service (refund provisions apply).

Common Causes

  • Documentation doesn't support the level, frequency, or duration billed
  • Diagnosis doesn't support medical necessity for the service under payer policy
  • Payer's coverage criteria (LCD/NCD or medical policy) not met

How to Resolve or Appeal

  1. Review the payer's specific medical necessity policy for this code
  2. Gather documentation that supports the service as billed
  3. Appeal with supporting clinical documentation if appropriate

More Denial Codes to Check

CARC CO-50 Non-covered because not deemed a medical necessity by the payer CARC CO-153 Payer deems the information submitted does not support this dosage CARC CO-55 Procedure/treatment/drug deemed experimental/investigational by the payer RARC N362 Number of days or units of service exceeds acceptable maximum CARC CO-154 Payer deems the information submitted does not support this day's supply RARC M42 CARC CO-56 Procedure/treatment not deemed 'proven to be effective' by the payer CARC CO-151 Payer deems the information submitted doesn't support this many/frequency of services

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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