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Error code

M6 — Maximum special visit premium reached - additional patient seen

Special visit premium limit

The maximum patients for special visit premiums in that time period was reached, so this extra patient's premium wasn't paid.

What to do: Check the premium's maximum for the setting and time period (Schedule GP65 to GP78) and count patients billed.

Code
M6
Description
Maximum special visit premium reached - additional patient seen

Explanation

Updated October 26, 2026

M6 means the special visit premium limit for that time period was reached, so this extra patient's premium wasn't paid.

What it means

M6 means the maximum for special visit premiums has been reached, and this line is for an additional patient seen. Many special visit premiums have a maximum number of patients per time period. Premiums for patients beyond that number are not paid (Schedule GP67).

The visit itself is assessed separately. M6 affects the premium.

Common causes

  • More patients were billed with a premium than the table allows for that time period
  • A premium was billed for a patient seen on the same trip after the limit was reached

How to fix it

  1. Check the special visit premium table for the setting and time period (Schedule GP65 to GP78) and its maximum.
  2. Count the patients billed with premiums for that time period.
  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 premium limit for that time period was 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: V2, VP

Sources