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M25 - Denial Journal
RARC

M25

Information furnished does not substantiate the need for this level of service

What This Code Means

The documentation submitted doesn’t support the specific level of service that was billed.

Common Causes

  • Notes don't reflect the complexity/time required for the billed level
  • Supporting documentation not submitted with the claim

How to Resolve or Appeal

  1. Review documentation against the requirements for that level of service
  2. Appeal with complete documentation, or resubmit at a supportable level

Related Codes

CO-150

More Denial Codes to Check

CARC CO-56 Procedure/treatment not deemed 'proven to be effective' by the payer RARC M42 RARC MA50 CARC CO-D2 CARC CO-261 The procedure or service is inconsistent with the patient's history CARC CO-154 Payer deems the information submitted does not support this day's supply CARC CO-57 CARC CO-55 Procedure/treatment/drug deemed experimental/investigational by the payer

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

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