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Error code

M5 — Monthly maximum has been reached

Monthly maximum reached

The monthly maximum for this service was already reached for the patient, so this one wasn't paid.

What to do: Check the code's monthly limit and which claims for the patient were paid that month.

Code
M5
Description
Monthly maximum has been reached

Explanation

Updated October 26, 2026

M5 means the monthly maximum for this service has been reached. Check what was already paid for the patient that month.

What it means

M5 means the service has a monthly maximum and it has already been reached. Services past the limit are not paid.

Monthly limits are set in each code's listing in the Schedule. For example, only one of the opioid agonist management codes K682 or K683 is paid per patient per month.

Common causes

  • The same monthly service was billed more than once for the patient
  • Another physician's claim for the month was paid first

How to fix it

  1. Check the fee code's monthly limit in the Schedule of Benefits.
  2. Check which claims for the patient were paid that month.
  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 monthly limit was already reached.
  • 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: MD, MY, M4

Sources