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RARC M97 · Remittance Advice Remark Code

RARC M97 Remark Code: Not paid to practitioner when provided to patient in this place of service. Pay…

QuickIntell editorial content · Legacy registry date · Review not verified

Updated

Not an ICD-10 code. RARC M97 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 M97 (X12 Not paid to practitioner when provided to patient in this place of service. Payment included in the…). Commonly paired with CARC 97, CARC B20. RARC M97 indicates professional service is already included in facility payment — remove the professional charge or rebill through the facility.

Reimbursement analyst and revenue manager reviewing a payment variance

Official X12 description

“Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.”

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 M97 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 97The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
CARC B20Procedure/service was partially or fully furnished by another provider.

CARCs CAQH CORE pairs with RARC M97

Under the CAQH CORE Payment and Remittance Uniform Use rule, a health plan that reports remark code M97 on an 835 should pair it with one of the 7 claim adjustment reason codes below, with the listed group code, for the business scenarios 3 (Billed service not covered by the health plan); 4 (Benefit for billed service not separately payable). A remark paired outside this list is itself a compliance question to raise with the payer.

CORE-required CARC and group code combinations that include RARC M97
CARCGroup codeScenario
96CO, PI or PR3: Billed service not covered by the health plan
97CO, PI or PR4: Benefit for billed service not separately payable
171CO, PI or PR3: Billed service not covered by the health plan
256CO, PI or PR3: Billed service not covered by the health plan
299CO, PI or PR3: Billed service not covered by the health plan
B13CO, PI or PR3: Billed service not covered by the health plan
P14CO, PI or PR4: Benefit for billed service not separately payable
Source: CAQH CORE-required Code Combinations v3.10.0 (2026-02), published by CAQH CORE (operating rules).

What RARC M97 actually means

RARC M97 indicates professional service is already included in facility payment — remove the professional charge or rebill through the facility.

Common root causes

  • Professional charge duplicates facility-included service.

Prevention checklist

  • Professional/facility billing separation rules.

Resolution & appeal strategy — step by step

Because RARC M97 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. 1Remove duplicate professional charge.
Sample reconsideration language referencing RARC M97
[Provider letterhead] Re: Reconsideration — Claim #{claim_number}, CARC 97 / RARC M97 Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} The 835 remittance on {remittance_date} carried RARC M97: "Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility." 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 M97?

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 M97

QuickRCM reads RARC M97 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 M97

What does RARC M97 mean?

RARC M97 is an X12 Remittance Advice Remark Code. The official X12 definition is: "Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.

Which CARC is paired with RARC M97?

RARC M97 is most commonly paired with CARC 97, CARC B20. 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 M97 remark on a remit?

Start from the root cause: Professional charge duplicates facility-included service. First step: Remove duplicate professional charge. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.

Where does RARC M97 appear on the 835 ERA?

RARC M97 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 M97 the same as ICD-10 code M97?

No. RARC M97 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.