Skip to main content

M85 Remark Code: E/M Services Were Reviewed

M85 means the payer reviewed the physician evaluation and management (E/M) services on the claim. The remark itself is explanatory; the CARC on the same line shows whether the review changed, reduced, or denied payment.

Quick facts

Code
M85 (RARC M85)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): If the review reduced or denied the E/M service, the adjustment is the provider's responsibility unless overturned.
  • PR (Patient Responsibility): Patient cost-sharing still applies to whatever amount the payer allowed after review.
Official description
Subjected to review of physician evaluation and management services.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M85 means

Evaluation and management visits are one of the most frequently reviewed service types because the level billed depends on documentation of medical decision making or time. M85 lets you know that the E/M services on this claim went through such a review, whether automated, clinical, or part of a targeted program.

M85 does not tell you the outcome. That comes from the reason code on the line:

  • If the line paid in full, the review supported your coding.
  • If the allowed amount dropped, the payer may have treated the visit as a lower level.
  • If the line was denied, the reviewer may have found it not necessary or included in another service.

Common causes

  • High-level E/M codes billed more often than peers in the same specialty.
  • E/M visits on the same day as procedures, where separate identification matters.
  • A payer program that reviews E/M claims from certain providers or specialties.
  • Documentation requests that were answered, then used to review the level.

What to do

  1. Read the CARC and compare payment to what you expected for the level billed.
  2. If the level was reduced, pull the visit note and check whether it supports the original level under current E/M guidelines.
  3. If you agree with the reduction, accept it and share the feedback with the provider.
  4. If you disagree, submit a reconsideration or appeal with the complete note and a brief explanation of how the documentation meets the level.

How to prevent it

  • Audit a sample of E/M visits per provider regularly and compare level distributions with specialty norms.
  • Train providers on documenting medical decision making or total time.
  • Watch for recurring E/M reductions with an ERA Analyzer.

For how remark codes and reason codes combine, see CARC and RARC analysis.

Codes that may appear with M85

  • CO-150 (Payer deems the information submitted does not support this level of service.): The reviewer decided the documentation did not support the level of E/M service billed.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The reviewer found the E/M service not medically necessary.
  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): The E/M service was considered part of another service, such as a procedure on the same day.
  • N22 (Alert: This procedure code was added/changed because it more accurately describes the services rendered.): An alert that the payer changed the procedure code to one it believes better describes the service.
  • M25 (The information furnished does not substantiate the need for this level of service.): The information furnished does not substantiate the level of service billed.
  • CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): Used when a review finds too many services, rather than too high a level.

M85 FAQ

Does M85 mean my E/M code was downcoded?

Not by itself. M85 only says a review happened. The paired CARC and the allowed amount tell you whether the level was changed.

What documentation do reviewers look at?

The visit note, including history, exam, medical decision making or time, and any supporting records that justify the level and medical necessity of the visit.

Can I appeal after an E/M review?

Yes. If you disagree with the result, follow the payer's reconsideration or appeal process and submit the full visit documentation.