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M87 Remark Code: CFO-CAP Prepayment Review

M87 means the claim or services were selected for a prepayment review under the program the official text calls CFO-CAP. Payment decisions were made after that review, and the CARC shows the outcome.

Quick facts

Code
M87 (RARC M87)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): If the review led to a denial or reduction, the provider absorbs it unless the decision is overturned.
  • OA (Other Adjustment): Some payers report the review status with an other-adjustment group while the line is being finalized.
Official description
Claim/service(s) subjected to CFO-CAP prepayment review.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M87 means

A prepayment review is an examination of a claim before the payer releases money, as opposed to an audit after payment. M87 tells you that the claim or specific services went through a review the official X12 description names CFO-CAP. The code dates to the original Medicare remark set, and payers today rarely explain the acronym on the remittance.

What matters for your team is the outcome. The CARC tells you whether the service was paid, reduced, or denied after review, and any other remark codes on the line explain why.

Common causes

  • The claim was chosen through sampling for a review program.
  • Documentation was requested and either reviewed or not received in time.
  • The service type or provider was part of a targeted review focus.

What to do

  1. Check the adjudication result on the line. If it paid as expected, record the review and move on.
  2. If it was denied for missing records, find out whether an additional documentation request was sent, and to which address.
  3. If it was denied on clinical grounds, review the documentation against the payer’s coverage policy.
  4. Appeal or request reconsideration with complete records if you disagree, within the payer’s time limits.
  5. Contact the Medicare contractor if you need to know why the claim was selected or whether more claims are affected.

How to prevent problems

  • Keep correspondence addresses current with each payer so record requests are not missed.
  • Log every documentation request with its due date.
  • Track reviewed claims with an ERA Analyzer to see whether reviews are clustering on certain services.

See CARC and RARC analysis for reading multi-code remittances.

Codes that may appear with M87

  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The prepayment reviewer found the service not medically necessary.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): Information requested for the review was not provided, not timely, or incomplete.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation is needed before the reviewed service can be adjudicated.
  • M95 (Services subjected to Home Health Initiative medical review/cost report audit.): A different review type: home health medical review or cost report audit.
  • M85 (Subjected to review of physician evaluation and management services.): A review focused on physician evaluation and management services.
  • OA-133 (The disposition of this service line is pending further review. (Use only with Group Code OA).): Reports a line that is still pending further review rather than finalized.

M87 FAQ

What is CFO-CAP?

It is the program name used in the official remark text, which dates to the original Medicare remark code set. The remark does not explain the program further, so contact the contractor if you need details about why your claim was selected.

Does a prepayment review mean fraud is suspected?

No. Prepayment reviews are used for many reasons, including sampling, error-rate measurement, and targeted review of billing patterns. The remark alone does not imply wrongdoing.

What should I do if records were requested?

Respond completely and before the stated deadline. Unanswered requests are a common reason reviewed claims are denied.