Skip to main content

M82 Remark Code: Not Covered When Patient Is Under 50

M82 means the payer does not cover this service for patients under age 50. It commonly appears on screening services with age-based coverage rules and usually accompanies an age-inconsistency or non-covered reason code.

Quick facts

Code
M82 (RARC M82)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The service is denied under age rules, and without a valid advance notice or plan provision, the provider absorbs it.
  • PR (Patient Responsibility): The payer assigns the amount to the patient, typically when a valid advance beneficiary notice or waiver was obtained.
Official description
Service is not covered when patient is under age 50.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M82 means

Some services are covered only once a patient reaches a certain age, and M82 applies to the age-50 threshold. The payer compared the patient’s date of birth to the date of service and found the patient was under 50, so the service falls outside coverage.

Age thresholds in coverage policies can change. If you believe the service should be covered for your patient’s age under current policy, check the payer’s latest rules rather than relying on older guidance.

Common causes

  • A screening service performed before the patient met the age requirement.
  • An incorrect date of birth in your system or in the payer’s enrollment file.
  • A diagnostic service coded as screening, so it fell under the screening age rule instead of diagnostic coverage.
  • A missing high-risk diagnosis where the policy allows earlier coverage for high-risk patients.

How to fix it

  1. Verify the patient’s date of birth against their ID card and the payer’s eligibility response.
  2. If the DOB was wrong, correct it and resubmit the claim.
  3. Review the coding. If the service was diagnostic because of signs or symptoms, confirm the documentation and code it as diagnostic with the supporting diagnoses.
  4. If a high-risk exception applies, add the qualifying diagnosis and resubmit, or appeal with records.
  5. If the denial is correct, bill the patient only when an advance notice or financial agreement permits it.

How to prevent it

  • Check age-based coverage rules during scheduling for screening services.
  • Obtain advance notices when a service may not be covered.
  • Confirm demographics at every visit; see eligibility and COB root causes.

Codes that may appear with M82

  • CO-6 (The procedure/revenue code is inconsistent with the patient's age.): The procedure is inconsistent with the patient's age on the date of service.
  • CO-96 (Non-covered charge(s).): A non-covered charge with M82 identifying the age limit as the reason.
  • N129 (Not eligible due to the patient's age.): A general age-eligibility remark that is not tied to a specific age threshold.
  • M83 (Service is not covered unless the patient is classified as at high risk.): Coverage depends on the patient being classified as high risk, another common screening condition.
  • M140Deactivated (Service not covered until after the patient's 50th birthday, i.e., no coverage prior to the day after the 50th birthday): A deactivated remark about coverage beginning after the 50th birthday.

M82 FAQ

What services does M82 usually apply to?

Services with coverage tied to age 50, most often certain screening services. The exact list depends on the payer's coverage policy, which may change over time.

What if the patient's date of birth is wrong?

Correct the DOB with the payer and on the claim (box 3 on the CMS-1500), then resubmit. A data error in the birth date is a frequent cause.

Can the patient be billed?

Only if the group code is PR or the patient agreed in advance to pay for a non-covered service, using the payer's required notice where applicable.