M176 | Service excluded

Industry

Healthcare

Canonical

/healthcare/error-codes/m176/

Last Updated

Feb 25, 2026

Summary

This code indicates that the billed service is excluded from coverage under the applicable payer policy.

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What This Code Means

M176 is used when a payer determines that a service falls outside covered benefits and is excluded by policy. This is a plan design or program rule, not a billing format issue. The exclusion applies regardless of how the service was billed. The code does not imply that the service was unnecessary or incorrectly performed. Coverage exclusions vary by program and payer.

Where Users Usually See This Code

Medicare remittance advice
Explanation of Benefits (EOB)
Claim denial summaries

Why This Code Appears

Service is excluded under policy rules
Program limitations apply
Coverage restrictions enforced

What Typically Happens Next

Payment is denied
Claim processing completes
Responsibility may transfer per policy

What This Code Is Not

It is not a documentation error
It is not a temporary processing hold
It is not a billing format issue

Troubleshooting Checklist

□ Review coverage exclusions
□ Confirm program eligibility
□ Monitor policy updates

Notes And Edge Cases

Coverage exclusions may differ between programs and plan years. Secondary coverage can affect final responsibility.

Related Codes

8 links

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