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M16 Remark Code: See Payer Policy Publications

M16 is an informational alert. It tells you the payer has published more detail about the policy, procedure, or decision applied to this claim on its website, in mailings, or in bulletins.

Quick facts

Code
M16 (RARC M16)
Status
Active In use since January 1, 1997; last modified April 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The adjustment falls on the provider under the policy the payer is referring you to.
  • PR (Patient Responsibility): The amount was assigned to the patient, and the published policy explains the basis.
Official description
Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M16 means

M16 is a signpost. The payer applied some policy or procedure to this line, and instead of spelling it out on the remittance, it refers you to its website, provider mailings, or bulletins. For Medicare, that usually means the Medicare Administrative Contractor’s site, local coverage determinations, and articles.

Because M16 carries no specific reason, everything depends on the claim adjustment reason code beside it.

What to do

  1. Read the paired CARC to learn what kind of decision was made.
  2. Search the payer’s provider site for the service and date of service, including coverage policies, billing articles, and recent bulletins.
  3. Compare your claim to the policy. Look for coverage criteria, required modifiers, diagnosis requirements, or frequency limits.
  4. Correct or appeal. Send a corrected claim if the policy points to a billing error; appeal if you believe the policy was misapplied.

When the same M16 combination keeps appearing, it usually points to a policy your billing rules do not yet reflect. Grouping remittance lines by CARC and RARC, as described in CARC and RARC denial analysis, helps you find it.

Codes that may appear with M16

  • CO-96 (Non-covered charge(s).): A non-covered charge, where the published policy describes the coverage limit.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): A medical necessity decision based on a published coverage policy.
  • CO-150 (Payer deems the information submitted does not support this level of service.): A level of service decision explained in a payer bulletin or policy.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to the patient's plan benefit documents rather than the payer's general publications.
  • N202 (Alert: Additional information/explanation will be sent separately.): Says more explanation will be sent separately, rather than pointing to existing publications.
  • N220 (Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.): Points to the payer's website or customer service for dispute forms and instructions.

M16 FAQ

Does M16 tell me which policy applies?

No. It only says the detail is published. Use the paired reason code, the service, and the date of service to find the right policy on the payer's site.

Is M16 itself a denial?

No. The reason code on the line carries the payment decision. M16 just tells you where to read more.

What if I cannot find the policy online?

Call the payer's provider services line with the claim number and ask which policy or bulletin was applied. Note the reference they give you for any appeal.