Skip to main content

M107 Remark Code: ESRD Hematocrit Average Above 36.5%

M107 means the payer reduced payment because the ESRD patient's 90-day rolling average hematocrit was above 36.5%. It relates to Medicare monitoring rules for anemia management drugs given to dialysis patients.

Quick facts

Code
M107 (RARC M107)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The reduction is a provider write-off under the payer's monitoring policy unless overturned.
Official description
Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M107 means

Dialysis patients with end-stage renal disease (ESRD) often receive drugs that stimulate red blood cell production. Because overly high blood counts can be harmful, Medicare developed monitoring rules that tie payment for these drugs to the patient’s lab values reported on the claim. M107 tells you the payer calculated a 90-day rolling average hematocrit above 36.5% and reduced payment accordingly.

Current Medicare policies for these drugs may use different measures or thresholds than those in the original remark. Always check the payer’s current guidance when interpreting M107.

Common causes

  • Hematocrit values above the threshold over the averaging period, with doses not reduced.
  • Lab values entered incorrectly on the claim, such as a transposed digit or a hemoglobin value reported as hematocrit.
  • Missing values in part of the averaging period, which changes the calculated average.
  • Doses and values from different dates matched incorrectly across claims.

How to fix it

  1. Check the lab values reported on this claim and the previous claims used in the average.
  2. If any value was wrong, correct it and submit a corrected claim with frequency code 7 for each affected claim.
  3. If values were right, review the medical record for documentation supporting the dosing, such as an explanation of why the dose was continued.
  4. Appeal with records if the dosing met the payer’s policy.

How to prevent it

  • Validate lab values against source reports before claims are released.
  • Review dosing protocols against current payer monitoring rules.
  • Track recurring reductions with an ERA Analyzer so clinical and billing teams can address them together.

Codes that may appear with M107

  • CO-150 (Payer deems the information submitted does not support this level of service.): The payer found the information did not support the amount of drug billed.
  • CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): The frequency or quantity of the drug was not supported by the reported lab values.
  • N396 (Incomplete/invalid laboratory report.): The laboratory report was incomplete or invalid, which can affect lab-based payment rules.
  • N386 (This decision was based on a National Coverage Determination (NCD).): The decision was based on a National Coverage Determination.

M107 FAQ

Which services does M107 affect?

Claims from ESRD facilities or providers for anemia management drugs, where payment depends on reported hematocrit or hemoglobin values.

What is a 90-day rolling average?

The average of the patient's reported hematocrit values over the most recent three months, recalculated each period.

Can the reduction be reversed?

Possibly. If the reported values were wrong or the medical record supports continued dosing under the payer's policy, correct the claim or appeal with documentation.