M86
Service denied — payment already made for the same/similar procedure within a set time frame
What This Code Means
The payer already paid for the same or a similar procedure within its allowed frequency window.
Common Causes
- Frequency limit for the procedure not checked before scheduling/billing
- Similar procedure billed twice within the payer's defined period
How to Resolve or Appeal
- Verify the payer's frequency limitation for this procedure
- Appeal with clinical justification if repeat service was medically necessary
More Denial Codes to Check
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.