Skip to main content

M104 Remark Code: New Rental Period at Fee Schedule Max

M104 means the payer accepted a break in therapy, so a new capped rental period begins with delivery of the equipment, and the amount paid is the maximum approved under the fee schedule for the item.

Quick facts

Code
M104 (RARC M104)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any charge above the fee schedule maximum is a contractual write-off for an assigned claim.
  • PR (Patient Responsibility): Deductible and coinsurance on the approved rental amount are the patient's share.
Official description
Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M104 means

M104 contains two separate messages for a DME supplier billing capped rental equipment.

First, the rental clock resets. The payer reviewed the information on the claim and agreed that the patient’s earlier need for this type of equipment ended and a new need began. A new capped rental period starts with this delivery.

Second, the payment is capped. The amount paid is the maximum the payer’s fee schedule allows for the item or service. If you billed more, the difference shows as an adjustment, usually a CO-45 on an assigned claim.

Compared with M93, M104 adds the fee schedule statement. Compared with M103, there is no reduction to a lower-level item.

When you see it

  • A returning patient receives rental equipment after a documented gap in need.
  • Your charge for the rental month exceeds the fee schedule amount.
  • The claim included the information the payer needed to accept the break.

What to do

  1. Post the payment and the fee schedule reduction as a contractual adjustment on an assigned claim.
  2. Collect the patient’s cost-sharing shown with group code PR.
  3. Reset the rental month count in your system so later claims report the right month.
  4. Keep the break-in-therapy documentation with the new order and delivery proof in case of later audit.
  5. Check the allowed amount against the published fee schedule for the patient’s area; if it looks low, contact the payer.

How to prevent confusion

  • Load current DME fee schedules for each payer so capped payments are expected, not investigated.
  • Track rental periods per patient and item class with delivery and pickup dates.
  • Compare rental payments month to month with an ERA Analyzer to catch unexpected drops.

Codes that may appear with M104

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The rental charge was reduced to the fee schedule maximum.
  • PR-2 (Coinsurance Amount): Patient coinsurance applied to the approved rental amount.
  • M93 (Information supplied supports a break in therapy.): Also confirms a new rental period after a break in therapy, without the fee schedule statement.
  • M105 (Information supplied does not support a break in therapy.): The break in therapy was not supported, and the item was paid at a reduced level.
  • M5 (Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer…): Describes how long capped rental payments can continue.

M104 FAQ

Is M104 a denial?

No. It confirms a new rental period and explains that payment was capped at the fee schedule maximum.

Why was I paid less than I billed?

Because the payer's fee schedule sets the most it will allow for the item. On assigned claims, the excess is usually written off.

Do I restart rental month modifiers?

Yes. With a new rental period, subsequent claims should report rental months counting from this delivery.