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MA126 Remark Code: Pancreas Transplant Needs Kidney

MA126 means the pancreas transplant is not covered unless a kidney transplant was performed. The payer denied it because the claim did not show the required kidney transplant.

Quick facts

Code
MA126 (RARC MA126)
Status
Active In use since October 12, 2001.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The transplant is not covered under the payer's rules and is a provider adjustment unless patient liability was properly established in advance.
  • PR (Patient Responsibility): If the patient agreed in advance to pay for a non-covered service under the payer's rules, the amount may be the patient's.
Official description
Pancreas transplant not covered unless kidney transplant performed.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA126 means

MA126 is a coverage remark for pancreas transplants. It tells you the payer does not cover the pancreas transplant unless a kidney transplant was performed, and the claim did not show that. The official text reflects the policy that pancreas transplants are tied to kidney transplantation, typically for patients with diabetes and kidney failure.

Common causes

  • A pancreas transplant was billed without the simultaneous kidney transplant on the same claim.
  • The patient had a prior kidney transplant, but the claim did not reflect that history.
  • The case was a pancreas transplant alone, which is covered only under specific criteria if at all.
  • Diagnosis coding did not reflect the kidney transplant status.

How to fix it

  1. Review the case to determine whether a kidney transplant was performed simultaneously or previously.
  2. Correct the claim if the kidney transplant or history was omitted, including diagnosis codes that reflect kidney transplant status.
  3. Check current coverage policy for the date of service.
  4. Appeal with documentation if the patient met the criteria.

How to prevent it

  • Verify coverage criteria and obtain any required approvals before transplant.
  • Make sure transplant claims include all related procedures and history.
  • Prior approval workflows are covered in authorization and referral denials.

Codes that may appear with MA126

  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Not deemed medically necessary under the payer's coverage criteria for pancreas transplant.
  • CO-96 (Non-covered charge(s).): A non-covered charge, with MA126 explaining the coverage condition.
  • N431 (Not covered with this procedure.): Not covered with this procedure, a general procedure-combination limit.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Directs you to plan documents for restrictions on the service.

MA126 FAQ

Is a pancreas transplant ever covered alone?

Coverage criteria are set by national and payer policy and have changed over time. Check the current coverage policy for the date of service, including any criteria for pancreas transplant alone.

What if the kidney transplant was done earlier?

If the patient had a prior kidney transplant, provide that history. Coverage policy may allow a pancreas transplant after a kidney transplant.

Can I appeal MA126?

Yes, if the patient met the coverage criteria. Submit documentation of the kidney transplant or other qualifying criteria with the appeal.