Already paid for the same or similar service in this period
The payer paid for the same or a similar service within a time window (frequency limit) and will not pay again.
Usual causes
- Preventive service, imaging or lab repeated sooner than the plan allows.
- DME item replaced before its useful life ended.
- Another provider was paid for the same service.
The fix
Check the frequency rule. If the repeat was medically necessary (changed condition, lost equipment), appeal with records. If another provider was paid, resolve it with the payer. Otherwise bill the patient only if they were informed (Medicare: ABN with GA).
Appeal or corrected claim?
Appeal with the clinical reason for the repeat; patient responsibility when a waiver was signed.
Deadline to watch
Appeal window per payer; Medicare redetermination 120 days.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
M86 in short
What does M86 mean?
The payer paid for the same or a similar service within a time window (frequency limit) and will not pay again. The official X12 text reads: "Service denied because payment already made for same/similar procedure within set time frame."
What usually causes a M86 denial?
Preventive service, imaging or lab repeated sooner than the plan allows. DME item replaced before its useful life ended. Another provider was paid for the same service.
How do I fix M86?
Check the frequency rule. If the repeat was medically necessary (changed condition, lost equipment), appeal with records. If another provider was paid, resolve it with the payer. Otherwise bill the patient only if they were informed (Medicare: ABN with GA).
Should I appeal M86 or send a corrected claim?
Correct or appeal (see note). Appeal with the clinical reason for the repeat; patient responsibility when a waiver was signed.
What deadline applies to M86?
Appeal window per payer; Medicare redetermination 120 days.