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M35 Remark Code (Deactivated): Pre-Op Photos/Visual Fields

M35 meant the payer needed pre-operative photos or visual field results and they were missing, incomplete, or invalid. X12 deactivated it and suggested N178 instead.

X12 deactivated RARCM35 on February 5, 2005. Payers should no longer use it on new remittances, but it can still appear on older ERAs, corrected claims, and appeals.

Code: M35 (RARC M35)
Status: Deactivated StoppedFebruary 5, 2005 (in use since January 1, 1997).
Code set: Remittance Advice Remark Codes (RARC)
Group codes: CO (Contractual Obligation): Usually paired with a CO documentation denial; supplying the images was the provider's job.
Official description: Missing/incomplete/invalid pre-operative photos or visual field results.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What M35 meant

For some surgeries, payers want to see the condition before treatment to decide whether the procedure is medically necessary rather than cosmetic. Remark M35 told the provider that the required pre-operative photographs or visual field test results were not received or did not meet requirements.

What replaced it

X12’s note suggested N178. N178 is the active remark for missing pre-operative images or visual field results, and N244 covers images or results that were sent but were incomplete or invalid. These usually accompany an attachment-related CARC such as CO-252.

If you still see M35

It is found only in older remittances. For a current request, check the payer’s coverage policy for exactly what images and tests it needs, gather them from the pre-operative workup, and send them through the attachment process with the claim number. Where these procedures require prior authorization, submitting the images at that stage avoids a later denial.

N178 (Missing pre-operative images/visual field results.): The suggested replacement: missing pre-operative images or visual field results.
N244 (Incomplete/Invalid pre-operative images/visual field results.): Incomplete or invalid pre-operative images or visual field results.
CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment or other documentation is required to adjudicate the claim.

M35 FAQ

Which procedures need pre-operative photos or visual fields?

Typically procedures that can be cosmetic or functional, such as some eyelid surgeries, where the payer wants evidence that the condition impairs function before covering it.

What makes these images invalid?

Payer policies often specify what the photos must show, such as particular views, and how visual field testing must be performed. Images that do not meet those specifications may not be accepted.

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