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MA56 Remark Code: Opted Out, Limiting Charge Still Applies

MA56 means Medicare's records show you have opted out and agreed not to bill Medicare, so it cannot pay the claim. The patient is responsible, but under federal law you cannot charge the patient more than the limiting charge amount.

Quick facts

Code
MA56 (RARC MA56)
Status
Active In use since January 1, 1997.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The patient is responsible for payment, capped at the limiting charge amount.
Official description
Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What MA56 means

MA56 combines two messages. First, Medicare considers you an opted-out provider, so it will not pay. Second, even though the patient is responsible, federal law caps what you can collect from the patient at the limiting charge. That cap is the key difference from MA47, where no such limit is stated.

The limiting charge is the maximum a non-participating provider may charge a Medicare beneficiary for a covered service. Its appearance here means Medicare believes charge limits apply to this particular service.

Common causes

  • The practitioner opted out and furnished a service without a valid private contract in a situation where charge limits apply.
  • The claim was billed under an opted-out rendering provider in error.
  • Enrollment records show an opt-out that the provider did not intend.

How to fix it

  1. Confirm opt-out status with the Medicare enrollment contractor.
  2. Check the private contract for this patient and date of service.
  3. Limit the patient’s bill to the limiting charge amount, and refund anything collected above it.
  4. Correct the rendering provider if the wrong one was listed, and resubmit.
  5. Fix enrollment if the opt-out status is wrong.

How to prevent it

Keep private contracts on file for every Medicare patient seen by an opted-out practitioner, and review charge rules for emergency or urgent situations. Details on enrollment status are in provider enrollment denials.

Codes that may appear with MA56

  • CO-B7 (This provider was not certified/eligible to be paid for this procedure/service on this date of service.): The provider was not eligible to be paid by Medicare for the service on the date of service.
  • CO-96 (Non-covered charge(s).): The service is treated as non-covered by Medicare.
  • MA47 (Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.): The same opt-out message without the limiting charge restriction.
  • MA13 (Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.): A warning about penalties for billing patients amounts outside PR.
  • MA12 (You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).): The right to bill for another's services has not been established.

MA56 FAQ

How is MA56 different from MA47?

Both say you opted out and Medicare will not pay. MA56 adds that federal law limits what you can charge the patient to the limiting charge amount.

When does the limiting charge apply to an opted-out provider?

Medicare rules cap charges in some situations involving opted-out providers, for example certain emergency or urgent care furnished to a beneficiary without a private contract. Confirm which rule applies to your case with the payer.

How do I find the limiting charge?

It is published in the Medicare fee schedule for your locality as a percentage above the non-participating fee schedule amount.