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M89 Remark Code: Only Once Before Age 40

M89 means the payer covers this service only once before the patient turns 40, and it has already been covered. Additional occurrences before age 40 are denied under the frequency rule.

Quick facts

Code
M89 (RARC M89)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The repeat service is a provider write-off unless the patient agreed in advance to pay.
  • PR (Patient Responsibility): The patient is responsible, typically because a valid advance notice of non-coverage was obtained.
Official description
Not covered more than once under age 40.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M89 means

M89 combines an age condition with a frequency limit. While the patient is younger than 40, the payer will cover this service one time. Once that single occurrence has been paid, any repeat before the 40th birthday is denied. After the patient reaches 40, a different frequency rule usually takes over.

Because M89 depends on both the patient’s age and their history, errors in either can trigger it.

Common causes

  • A second baseline or screening service performed before age 40.
  • The first service was performed by a different provider, and your practice did not know.
  • An incorrect date of birth that makes the patient look younger than they are.
  • A diagnostic service billed as a screening service.

How to fix it

  1. Verify the date of birth against the payer’s records and box 3 of the claim.
  2. Ask for or check the patient’s history of the service before age 40.
  3. If the service was diagnostic, make sure it is coded that way with the symptom or condition diagnoses, and send a corrected claim with frequency code 7.
  4. If the DOB was wrong, fix it and resubmit.
  5. If the denial is valid, bill the patient only when an advance notice supports it; otherwise write it off.

How to prevent it

  • Ask patients about prior screening at scheduling and record outside results.
  • Use advance notices when a repeat may not be covered.
  • Validate demographic data at registration; eligibility root causes covers why this matters.

Codes that may appear with M89

  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): The benefit limit for this service has been reached for the age period.
  • CO-6 (The procedure/revenue code is inconsistent with the patient's age.): The service is inconsistent with the patient's age as billed.
  • CO-96 (Non-covered charge(s).): A non-covered charge with M89 naming the age-and-frequency limit.
  • M90 (Not covered more than once in a 12 month period.): A once-per-12-months limit that is not tied to age.
  • M82 (Service is not covered when patient is under age 50.): Service not covered at all under age 50.
  • N117 (This service is paid only once in a patient's lifetime.): A limit of once in a lifetime, regardless of age.

M89 FAQ

What kind of services have a once-under-40 rule?

Typically screening services where a single baseline test is allowed before routine screening begins. The specific services depend on the payer's coverage policy.

What if the earlier service was with another provider?

The limit still applies. The payer looks at the patient's history across providers.

Could a diagnostic service be denied with M89?

It should not be if it is properly coded as diagnostic. If a diagnostic service was coded as screening, correct the coding with supporting diagnoses and resubmit.