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Error code

M4 — Maximum reached for these services (one or more practitioners)

Maximum already reached

The maximum fee or number of services for this code was reached, counting claims by you and other physicians.

What to do: Check the code's limit and which services were already paid for the patient in that period, by any physician.

Code
M4
Description
Maximum reached for these services (one or more practitioners)

Explanation

Updated October 26, 2026

M4 means the maximum for these services has been reached, counting claims by you and other physicians. Check what was already paid.

What it means

M4 means the maximum fee or number of services allowed has been reached. The count includes services by one or more practitioners, so another physician's claims can use up the limit.

Under the Schedule's rules (GP7), a maximum without a time period means per patient per day. A maximum with a time period is counted per patient in date order, and services past it are not paid.

Common causes

  • The same service was billed for the patient by another physician in the same period
  • More services were billed than the listing allows

How to fix it

  1. Check the fee code's limits in the Schedule of Benefits.
  2. Check which services were already paid for the patient in the limit period, by any physician.
  3. If you believe the decision is wrong, send a Remittance Advice Inquiry (RAI) through eSubmit, or on form 0918-84, within 7 months of the RA date, with supporting details.

Don't resubmit if

  • The limit was already reached by paid services.
  • The line is already on your RA. Question it with an RAI, not a new claim.

How APEX handles it

APEX reads your error reports and remittance advice from MCEDT and lists claims rejected with this code in its Correction Centre for you to correct and resubmit. See how APEX works · Pricing

Related codes: M1, M2, MY, MD

Sources