Healthcare Error Code
Healthcare Insurance / Medical Billing
Common CMS / Medicare Issues
M62 | Service not medically necessary
Industry
Healthcare
Canonical
/healthcare/error-codes/m62/
Last Updated
Feb 25, 2026
Summary
This code indicates that CMS determined the service did not meet medical necessity criteria under Medicare policy.
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What This Code Means
M62 is used when a service does not meet CMS medical necessity guidelines. This determination is based on policy criteria rather than billing accuracy. It does not imply improper service delivery. Coverage decisions depend on established Medicare rules and documentation standards.
Where Users Usually See This Code
- Medicare EOB statements
- Remittance advice
- Coverage determination notices
Why This Code Appears
- Service does not meet CMS necessity criteria
- Policy guidelines restrict reimbursement
- Documentation does not support necessity
What Typically Happens Next
- Payment is denied
- Claim is closed
- Appeal options may exist under CMS rules
What This Code Is Not
- It is not a billing format error
- It is not a contractual adjustment
- It is not a system malfunction
Troubleshooting Checklist
- □ Review CMS medical necessity policies
- □ Confirm documentation requirements
- □ Monitor policy updates
Notes And Edge Cases
Medical necessity criteria may change over time. CMS policies are applied uniformly but can differ from commercial payers.
Related Codes
8 links
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