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RARC M115 · Remittance Advice Remark Code

RARC M115 Remark Code: This item is denied when provided to this patient by a non-contract or non-demo…

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

Not an ICD-10 code. RARC M115 is a remittance-advice remark code published by X12 and carried on the 835 LQ segment. Any ICD-10 code with the same letters and digits (e.g., ICD-10 M15 osteoarthritis, N130 other urinary tract disorders) is a separate, unrelated code set used in diagnoses on the 837. Confirm the context before acting on this page.

TL;DR

RARC M115 (X12 This item is denied when provided to this patient by a non-contract or non-demonstration supplier). Commonly paired with CARC 96, CARC 170. RARC M115 denies DMEPOS/labs from non-contract suppliers under CMS Competitive Bidding.

Official X12 description

“This item is denied when provided to this patient by a non-contract or non-demonstration supplier.”

Source: X12 Remittance Advice Remark Codes. X12 publishes and maintains the RARC set; always verify against the current release before building a claim workflow.

Paired CARC codes

RARC M115 almost never appears alone — it accompanies one of the CARCs below on the same 835 remittance line. Fix the CARC and the RARC typically clears; the RARC alone is informational.

Paired CARCWhat the CARC means
CARC 96Non-covered charge(s).
CARC 170Payment is denied when performed/billed by this type of provider.
CARC 185The rendering provider is not eligible to perform the service billed.

What RARC M115 actually means

RARC M115 denies DMEPOS/labs from non-contract suppliers under CMS Competitive Bidding. Patient must use a contracted supplier; otherwise the service is non-covered.

Common root causes

  • Competitive-bid service provided by non-contract supplier.

Prevention checklist

  • Direct patients to contract suppliers for CBP items.

Resolution & appeal strategy — step by step

Because RARC M115 is supplemental to a CARC, the resolution path usually starts by fixing the underlying adjustment reason. A formal appeal of the RARC alone is rarely necessary.

  1. 1Not typically appealable. Rebill patient or refer to contract supplier.
Sample reconsideration language referencing RARC M115
[Provider letterhead] Re: Reconsideration — Claim #{claim_number}, CARC 96 / RARC M115 Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} The 835 remittance on {remittance_date} carried RARC M115: "This item is denied when provided to this patient by a non-contract or non-demonstration supplier." We request reconsideration. The attached documentation rebuts the remark code: 1. [State the fact that rebuts the remark — authorization number, primary 835, modifier rationale, LCD citation, etc.] 2. [Reference the paired CARC and the corresponding fix] 3. [Attach the supporting document listed in step 1] Attached: {list supporting documents} Please process this line under the member's benefits. Contact the billing office at {provider_phone} for questions. Sincerely, {billing_manager_name}, {credentials}

Edit the bracketed fields before sending. Payer-specific reconsideration forms are often required — check the provider portal first.

How common is RARC M115?

Platform frequency
Pending ETL

Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).

How QuickRCM handles RARC M115

QuickRCM reads RARC M115 alongside its paired CARC in the 835 LQ segment and routes the line to the correct worker queue with the right documentation already attached:

  • Denial routing rules tuned to the CARC+RARC pair — the paired combination tells QuickRCM which documentation the payer will accept.
  • Reconsideration template for this exact remark code pulls the supporting facts from the claim automatically.
  • Pre-submission scrubs that catch the preventable drivers surfaced on this page before the 837 leaves the clearinghouse.
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Frequently asked questions — RARC M115

What does RARC M115 mean?

RARC M115 is an X12 Remittance Advice Remark Code. The official X12 definition is: "This item is denied when provided to this patient by a non-contract or non-demonstration supplier." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.

Which CARC is paired with RARC M115?

RARC M115 is most commonly paired with CARC 96, CARC 170, CARC 185. The CARC is the financial adjustment reason; the RARC is the informational remark. Fix the paired CARC first — the RARC usually clears with the corrected claim.

How do I resolve a RARC M115 remark on a remit?

Start from the root cause: Competitive-bid service provided by non-contract supplier. First step: Not typically appealable. Rebill patient or refer to contract supplier. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.

Where does RARC M115 appear on the 835 ERA?

RARC M115 is carried on the 835 Loop 2110 LQ segment alongside the CARC in the CAS segment of the same service line. The code and its X12 description also print on the paper EOB in the "Remark Code" or "Remark" column next to the corresponding denial or adjustment reason.

Is RARC M115 the same as ICD-10 code M115?

No. RARC M115 is a remittance-advice remark code published by X12 and carried on the 835. Any ICD-10 code with the same letters and digits is a diagnosis code on the 837 HI segment — a completely different code set maintained by the WHO/CMS. Use the transaction context (835 = RARC; 837 = ICD-10) to disambiguate.

Disclaimer

This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. X12 code descriptors are maintained by the X12 External Code Lists; always verify against the current X12 release and the payer's own published policy before submitting or appealing a claim.