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Remittance advice remark code

M115: Denied — not a contract supplier for this item

M115 means: This item is denied when provided to this patient by a non-contract or non-demonstration supplier. A DMEPOS competitive bidding denial: for this item, in this area, Medicare pays only suppliers holding a contract, and this claim came from one that does not.

M115 is a remark code, not a reason code

It explains or adds detail to a decision. It does not carry a group code, and it can never on its own make a balance the patient’s responsibility. The claim adjustment reason code on the same remittance line is what actually decides the outcome — read that first, then read this for the detail.

CARC — claim adjustment reason code. What was adjusted, and under which group code.
RARC — remittance advice remark code, like this one. Explanatory only. No group code, no patient responsibility.
Never move a balance to the patient on the strength of a remark code. Find the reason code and read its group code.

What causes it

The item falls in a competitively bid product category for the patient’s area and the supplier holds no contract for it
The patient moved into a competitive bidding area and the supplier did not check
A grandfathering or demonstration exception that applies but was not claimed on the claim

How to work it

Check the current status of the Competitive Bidding Program for the product category and the patient’s ZIP code on the CMS DMEPOS competitive bidding site before anything else — rounds start and end, and the answer changes with them.
If the program applies and you are not a contract supplier, the claim is not payable to you; the patient must obtain the item from a contract supplier, and any signed notice you hold decides whether the patient can be billed.
If an exception applies — a grandfathered rental, a demonstration — resubmit with the modifier or documentation the exception requires.

How to stop it recurring

Verify the patient’s address against the competitive bidding areas at intake for every bid-category item, and keep the program’s round dates on the DME desk’s calendar.

Who does this work

A dme & orthotics billing seat at $1,800 per seat per month works this queue full time, during your business hours, inside your own system. Every call is logged with the payer reference number and the outcome, and every Friday you get it in writing.

What that seat does →

Codes worked the same way

M115 is fixed in credentialing, not on the claim. So are these, which is why a queue sorted by recovery route moves faster than one sorted by code number — the same person, in the same system, with the same evidence to hand, clears all of them in one pass.

CO-B7 — Provider not eligible that day
CO-185 — Rendering provider not eligible
CO-8 — Procedure and provider type disagree
CO-107 — Qualifying claim not identified
CO-183 — Referring provider not eligible
CO-184 — Ordering provider not eligible

Specialties that name this among their costliest

These are specialties whose own worst denials include one of this kind. The line under each is the denial they name, quoted from their page so you can see what the link is based on.

Pediatrics
Newborn claims denied because the baby was never added to the policy inside the enrollment window
Pulmonology and Critical Care
Sleep study interpretation billed without the qualifying supervision or credentials

What leaving it costs

Working a denied claim costs $57.23 per denied claim in administrative time. Source. At 100 denials a month — an illustration, not a measurement of your practice — that is $5,723 a month, or $68,676 a year, in labour alone.

The figure that makes it worth spending: about 90% of initially denied claims are eventually paid. Source. The reason a denial sits is almost never that nobody knows how to work it — it is that nobody has the hours.

Questions

What does denial code M115 mean?

This item is denied when provided to this patient by a non-contract or non-demonstration supplier. In plain terms: A DMEPOS competitive bidding denial: for this item, in this area, Medicare pays only suppliers holding a contract, and this claim came from one that does not.

What causes M115?

The item falls in a competitively bid product category for the patient’s area and the supplier holds no contract for it. The patient moved into a competitive bidding area and the supplier did not check. A grandfathering or demonstration exception that applies but was not claimed on the claim.

How do you fix a M115 denial?

Check the current status of the Competitive Bidding Program for the product category and the patient’s ZIP code on the CMS DMEPOS competitive bidding site before anything else — rounds start and end, and the answer changes with them.. If the program applies and you are not a contract supplier, the claim is not payable to you; the patient must obtain the item from a contract supplier, and any signed notice you hold decides whether the patient can be billed.. If an exception applies — a grandfathered rental, a demonstration — resubmit with the modifier or documentation the exception requires..

Can M115 be prevented?

Verify the patient’s address against the competitive bidding areas at intake for every bid-category item, and keep the program’s round dates on the DME desk’s calendar.

What about the codes next to M115?

M114 and M116 are separate codes and this site does not yet cover them. The authoritative list is the X12 Remittance Advice Remark Codes at x12.org/codes/remittance-advice-remark-codes; a code is only described here once its official text, causes and fix have been written and checked.

Code descriptions are the standard X12 claim adjustment reason and remittance advice remark code text. Payer policies differ, and the payer’s own coverage policy governs any individual claim. This page is working guidance, not legal or clinical advice.

Last updated 2026-09-12. This is operational guidance drawn from payer remittance practice, not legal, coding or reimbursement advice. Payer-specific rules vary and change; confirm against the payer’s own policy before acting on a specific claim.

Written by Ibtesam Asif · Last reviewed 2026-09-12

Code descriptions are the standard published text. Everything after them is operational guidance from our own work, and payer policy governs any individual claim.

Other denial codes

Next step

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