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M60 Remark Code: Certificate of Medical Necessity Missing

M60 means the payer required a Certificate of Medical Necessity for this item or service and did not have one. The claim cannot be paid until the CMN is submitted.

Quick facts

Code
M60 (RARC M60)
Status
Active In use since January 1, 1997; last modified August 1, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The supplier absorbs the amount until the CMN is provided. It is not billed to the patient.
Official description
Missing Certificate of Medical Necessity.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M60 means

A Certificate of Medical Necessity (CMN) is a form in which the treating practitioner attests that the patient meets the payer’s coverage criteria for an item, typically durable medical equipment. M60 says the payer needed a CMN for this claim and found none on file or in the claim data.

It is a Medicare DMEPOS remark at its core, and its sibling N227 covers CMNs that were sent but are incomplete or invalid.

Common causes

  • The CMN data was not transmitted with the electronic claim.
  • The CMN was obtained after delivery and never submitted.
  • A new CMN was needed after a change in the order, such as a new prescribed flow rate, and was not sent.
  • The claim was sent under a different supplier number than the CMN.
  • The item code changed and the CMN was linked to the old code.

How to fix it

  1. Confirm a signed CMN exists and covers the item and dates billed.
  2. If none exists, get the treating practitioner to complete and sign it.
  3. Transmit the CMN data as required and resubmit the claim, often as a new claim if the original was unprocessable.
  4. Review other claims for the same patient and item that may also lack a CMN.

How to prevent it

Make the CMN a hard requirement in your DME order intake for items that need one, and track revision and recertification triggers. A Claims Validator check can confirm required documentation before claims go out. See the CO-16 guide.

Codes that may appear with M60

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Required information, the CMN, is missing.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment or documentation is required.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Without the CMN, medical necessity is not established.
  • N227 (Incomplete/invalid Certificate of Medical Necessity.): The CMN was received but is incomplete or invalid.
  • M19 (Missing oxygen certification/re-certification.): The oxygen-specific certification or recertification is missing.
  • M42 (The medical necessity form must be personally signed by the attending physician.): The medical necessity form lacks the attending physician's personal signature.

M60 FAQ

Which items need a CMN?

Historically, Medicare required CMNs for items such as home oxygen and certain other DME. The list has been reduced over time, so check the DME contractor's current requirements.

Is the CMN sent with the claim?

For electronic claims, CMN information is transmitted in the claim's certification segment. The signed original stays on file with the supplier.

Who completes the CMN?

The supplier can fill in its own sections, but the treating practitioner must complete and sign the clinical sections.