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RARC
M26
RARC
Medical Necessity
Quick Facts
Code
M26
Type
RARC
Category
Medical Necessity
Status
Active
What Does This Code Mean?
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
Recommended Next Steps
- Review the payer's specific medical necessity policy for this code
- Gather documentation that supports the service as billed
- Appeal with supporting clinical documentation if appropriate
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Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.