Skip to main content

M109 Remark Code: Teleconsultation Payment Share

M109 means the payer made a single bundled payment for a teleconsultation, and you must send 25 percent of that payment to the referring practitioner. It reflects a payment-sharing rule, not a denial.

Quick facts

Code
M109 (RARC M109)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any fee schedule adjustment on the teleconsultation is a contractual write-off; M109 addresses how the paid amount is shared.
  • PR (Patient Responsibility): Patient cost-sharing on the teleconsultation is reported separately and unaffected by the split.
Official description
We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M109 means

M109 comes from an early Medicare approach to telehealth consultations. Under that approach, one bundled payment was made to the consulting practitioner, who was then responsible for passing 25 percent of it to the referring practitioner, the one who was with the patient and arranged the consultation.

The remark is an instruction about the payment you received, not a reason for nonpayment. The payer has already paid; you are responsible for completing the split.

Telehealth payment rules have changed significantly since this code was created, and payers today usually pay each practitioner’s services separately. If you receive M109, confirm how the payer calculated the payment.

When you see it

  • A teleconsultation was paid under a bundled method.
  • The claim identified a referring practitioner.
  • The payer’s policy assigns part of the payment to that referring practitioner.

What to do

  1. Confirm the payment amount for the teleconsultation line.
  2. Calculate 25 percent of the payment and identify the referring practitioner named on the claim.
  3. Send the share to the referring practitioner and keep a record of the transfer.
  4. Ask the payer if you believe the teleconsultation should have been paid under a different method, or if the referring practitioner already billed separately.

Keeping records straight

  • Post the full payment, then record the outgoing share separately so reconciliation stays clean.
  • Keep referring practitioner NPIs accurate in box 17 and 17b.
  • Review CARC and RARC analysis for reading payment remarks that are not denials.

Codes that may appear with M109

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge was reduced to the allowed amount for the teleconsultation.
  • PR-2 (Coinsurance Amount): Coinsurance applied to the teleconsultation.
  • N655 (Payment based on provider's geographic region.): Payment based on the provider's geographic region, which can also factor into telehealth eligibility.
  • M77 (Missing/incomplete/invalid/inappropriate place of service.): A place of service problem, common on telehealth claims.

M109 FAQ

Why must I share 25 percent?

The remark reflects an older Medicare payment approach for teleconsultations in which the consulting practitioner was paid and required to share part of the payment with the practitioner who referred the patient and presented them.

Is M109 still common?

Current Medicare telehealth rules pay distant site and originating site services separately, so this remark is uncommon today. If you receive it, ask the payer which payment method it applied.

Does the patient pay more because of the split?

No. The split is between practitioners and does not change patient cost-sharing.