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M122 Remark Code: Level of Subluxation Missing or Invalid

M122 means the level of subluxation on a chiropractic claim was missing, incomplete, or invalid. Payers need the specific spinal region or level treated to confirm the manipulation is covered, so the claim must be corrected.

Quick facts

Code
M122 (RARC M122)
Status
Active In use since January 1, 1997; last modified February 28, 2006.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The manipulation was not paid due to missing clinical data. The chiropractor corrects and resubmits; the patient is not billed.
Official description
Missing/incomplete/invalid level of subluxation.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M122 means

For chiropractic manipulation, payers such as Medicare cover treatment to correct a subluxation of the spine. To evaluate the claim, they need to know where the subluxation is: which spinal region or vertebral level. M122 says that information was absent or unusable.

Because the manipulation code billed reflects the number of regions treated, the reported levels also need to support that number. A claim that bills more regions than it documents can trigger this remark or a diagnosis consistency denial.

Common causes

  • Subluxation diagnosis codes omitted, with only symptom codes such as pain reported.
  • Diagnoses that do not identify the spinal region.
  • Fewer regions supported by diagnoses than the manipulation code implies.
  • Payer-specific fields for subluxation level or x-ray date left blank.
  • Diagnosis pointers in box 24E that do not link the subluxation diagnoses to the manipulation line.

How to fix it

  1. Review the treatment note for the regions and levels documented.
  2. Report subluxation diagnoses for each region treated, as the payer’s policy requires, and link them to the manipulation line.
  3. Check that the manipulation code matches the number of regions supported.
  4. Complete any payer-required fields, such as initial treatment date or x-ray date.
  5. Resubmit, as a corrected claim with frequency code 7 if the original was adjudicated.

How to prevent it

  • Use chiropractic templates that require region-specific subluxation findings.
  • Build a pre-billing edit comparing regions billed to diagnoses reported.
  • Run claims through a Claims Validator to catch missing pointers.

Codes that may appear with M122

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information, and M122 names the level of subluxation.
  • CO-11 (The diagnosis is inconsistent with the procedure.): The diagnosis does not support the number of spinal regions treated.
  • M111 (We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.): Manipulation denied because the patient refused an x-ray.
  • M1 (X-ray not taken within the past 12 months or near enough to the start of treatment.): The x-ray was not recent enough to support treatment.
  • MA122 (Missing/incomplete/invalid initial treatment date.): The initial treatment date was missing or invalid, another chiropractic data element.

M122 FAQ

How is the level of subluxation reported?

Usually through diagnosis codes that identify the spinal region or segment, plus any payer-specific claim fields. Medicare requires the subluxation diagnosis for the region treated.

Does the number of regions matter?

Yes. Manipulation codes are defined by the number of spinal regions treated, and payers expect diagnoses that support each region billed.

Is M122 appealable?

It is a data problem, so correct the claim rather than appealing.