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M105 Remark Code: No Break in Therapy, Reduced Payment

M105 means the payer found no break in therapy and did not find support for the item as billed. It paid at a reduced level and the existing capped rental period continues; no new rental period begins.

Quick facts

Code
M105 (RARC M105)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The reduction from the billed item to the approved level is a supplier write-off unless an advance notice shifted it to the patient.
  • PR (Patient Responsibility): The patient may owe the upgrade difference only when a valid advance notice was signed.
Official description
Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M105 means

M105 is the least favourable of the break-in-therapy remarks. It tells a DME supplier three things at once:

  1. The payer did not accept that the patient’s need for this equipment ended and restarted, so there is no new capped rental period.
  2. The medical information does not support the item as billed, for example an advanced model where the payer sees need only for a basic one.
  3. The payer approved payment at a reduced level rather than denying outright.

Because the rental continues under the old period, the months already billed count toward the cap. Combined with a lower monthly amount, total payment for the item may drop significantly.

Common causes

  • A short gap between rentals that does not meet the payer’s break-in-need rules.
  • Missing discontinuation records from the earlier rental, possibly from a different supplier.
  • An order and clinical notes that justify basic equipment but not the features billed.
  • Missing qualifying tests or measurements required for the higher level of item.

How to fix it

  1. Separate the issues. Review the break-in-therapy decision and the item-level decision independently.
  2. For the rental period, gather pickup dates, discontinuation notes, and evidence of the new need.
  3. For the item level, gather clinical notes and test results that explain why the patient needs that specific item.
  4. File a reconsideration or appeal addressing both points, within the payer’s time limits.
  5. Update your rental records to continue the existing month count until any appeal succeeds.

How to prevent it

  • Check the payer’s rental history before delivering to a returning patient.
  • Obtain an advance notice when furnishing an upgrade that may be reduced.
  • Confirm the order documents both the new need and the features required.

Codes that may appear with M105

  • CO-150 (Payer deems the information submitted does not support this level of service.): The information does not support the level of equipment billed.
  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): Rental months in the continuing period may already be near or at the cap.
  • M94 (Information supplied does not support a break in therapy.): No break in therapy, but without a finding about the item's level.
  • M103 (Information supplied supports a break in therapy.): Break in therapy accepted, with the item paid at a reduced level.
  • M3 (Equipment is the same or similar to equipment already being used.): Equipment is the same or similar to equipment already in use.

M105 FAQ

What are the two problems in M105?

The rental period does not restart, and the item was paid as a lower-level item. Each needs its own review.

Can I appeal just one part?

Yes. You can contest the break-in-therapy finding, the level of the item, or both, with records that address each point.

What happens to future rental months?

They count toward the existing rental period. If that period's cap is reached, further monthly payments may stop.