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M94 Remark Code: Break in Therapy Not Supported

M94 means the information supplied does not support a break in therapy for this capped rental equipment. A new rental period will not start, so the item continues under the existing rental period and cap.

Quick facts

Code
M94 (RARC M94)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Rental payments beyond what the existing period allows are provider write-offs unless the decision is overturned.
  • PR (Patient Responsibility): Patient cost-sharing still applies to any rental months the payer does pay within the existing period.
Official description
Information supplied does not support a break in therapy. A new capped rental period will not begin.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M94 means

For capped rental equipment, restarting the rental clock requires a break in therapy the payer accepts. M94 tells you the payer reviewed the claim and did not find enough support for that break. As a result, the current rental is treated as a continuation of the earlier one. If the earlier period was already at or near its cap, this can mean little or no further rental payment.

M94 is the counterpart of M93, where the break was accepted.

Common causes

  • The gap between the end of the old need and the start of the new one was shorter than the payer’s minimum.
  • Pickup or discontinuation dates from the prior rental were not documented.
  • The new order did not describe a new medical need, only continued use.
  • A different supplier furnished the earlier rental, and the payer’s history shows continuous use.
  • A required break-in-need modifier or explanatory narrative was omitted.

How to fix it

  1. Pull the rental history for the item class, including dates from any previous supplier.
  2. Compare the gap with the payer’s break-in-therapy requirements.
  3. If you have evidence that the need ended and a new need began, submit a reconsideration or appeal with the discontinuation records, new order, and clinical notes.
  4. If the payer is right, adjust your rental count and stop billing months beyond the cap for the existing period.

How to prevent it

  • Record pickup dates and reasons for discontinuation for every rental.
  • Before delivering to a returning patient, check prior rental history with the payer.
  • Document the new medical need clearly on the new order.

Codes that may appear with M94

  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): The rental cap or benefit maximum for the existing period has already been reached.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The payer did not find a new medical need that would justify a new rental period.
  • M93 (Information supplied supports a break in therapy.): The break in therapy was accepted and a new rental period began.
  • M103 (Information supplied supports a break in therapy.): A break was accepted, but payment for the item was reduced.
  • M3 (Equipment is the same or similar to equipment already being used.): The equipment is the same as or similar to equipment already in use.

M94 FAQ

Why would a break in therapy be rejected?

Usually the gap was shorter than the payer requires, or the documentation did not show that the earlier need ended and a new need began.

What happens to the rental months?

They continue counting from the original rental period. If the cap was reached, further rental payments may be denied.

Can I appeal M94?

Yes, if you have records showing the earlier need ended and a new one began, with dates that meet the payer's break-in-therapy rule.