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M42 - Denial Journal
RARC

M42

What This Code Means

The medical necessity form must be personally signed by the attending physician.

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-153 Payer deems the information submitted does not support this dosage CARC CO-50 Non-covered because not deemed a medical necessity by the payer RARC M25 Information furnished does not substantiate the need for this level of service CARC CO-55 Procedure/treatment/drug deemed experimental/investigational by the payer CARC CO-154 Payer deems the information submitted does not support this day's supply CARC CO-152 Payer deems the information submitted does not support this length of service CARC CO-57 RARC M10 CARC CO-150 Payer deems the information submitted does not support this level of service CARC CO-261 The procedure or service is inconsistent with the patient's history CARC CO-D2 RARC N362 Number of days or units of service exceeds acceptable maximum

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

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