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M95 Remark Code: Home Health Review or Cost Report Audit

M95 means the home health services on the claim were subjected to a Home Health Initiative medical review or cost report audit. The CARC on the line shows whether that review changed payment.

Quick facts

Code
M95 (RARC M95)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any denial or reduction resulting from the review is the agency's responsibility unless overturned.
  • OA (Other Adjustment): Some payers use an other-adjustment group when reporting the effect of an audit rather than a claim-level decision.
Official description
Services subjected to Home Health Initiative medical review/cost report audit.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What M95 means

M95 is a Medicare remark aimed at home health agencies. It tells you the services on the claim were part of a Home Health Initiative medical review, or were affected by a cost report audit. Medical review looks at whether the services met coverage rules and were supported by documentation. A cost report audit looks at the agency’s reported costs, which can affect settlement amounts.

The remark itself does not state an outcome. Read the CARC on each line to see whether services were paid, reduced, or denied.

Common causes

  • The agency or the service type was selected for a targeted medical review.
  • A documentation request was sent as part of the review.
  • A cost report audit adjustment was applied to the period covering the claim.

What to do

  1. Check each line’s CARC to see the effect of the review.
  2. Locate the related correspondence, such as additional documentation requests or audit findings, and confirm deadlines.
  3. If services were denied for documentation, gather the certification, plan of care, visit notes, and orders, and request reconsideration or appeal within the payer’s time limits.
  4. If a cost report audit is involved, coordinate with whoever prepares your cost reports, since those disputes follow a separate process.

How to prevent problems

  • Audit plans of care and face-to-face documentation before billing.
  • Maintain a single log of documentation requests with due dates.
  • Keep correspondence addresses current with the Medicare contractor so requests are not missed.
  • Group denials by reason with an ERA Analyzer to see whether reviews are finding the same problem repeatedly.

Codes that may appear with M95

  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The review found the home health services not medically necessary.
  • CO-226 (Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.): Records requested for the review were not provided in time or were incomplete.
  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation is required before the payer will finish adjudicating.
  • M87 (Claim/service(s) subjected to CFO-CAP prepayment review.): A prepayment review under a different program name, not specific to home health.
  • N238 (Incomplete/invalid physician certified plan of care.): The physician-certified plan of care was incomplete or invalid, a common home health review finding.
  • M141 (Missing physician certified plan of care.): The physician-certified plan of care was missing.

M95 FAQ

Who receives M95?

Home health agencies, since the remark refers to a home health review initiative and to cost reports, which agencies file with Medicare.

Does M95 mean money will be taken back?

Not necessarily. It says a review or audit occurred. Whether payment changed depends on the CARC and any separate audit correspondence.

What records are usually reviewed?

Typically the certification of eligibility, plan of care, visit notes, and orders. The review letter or request will list what is needed.