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Error code

MY — Yearly maximum has been exceeded

Yearly maximum exceeded

The yearly maximum for this service has been exceeded for the patient, so services past the limit weren't paid.

What to do: Check whether the code's limit is per calendar year or per 12 months, and count services paid in that period.

Code
MY
Description
Yearly maximum has been exceeded

Explanation

Updated October 26, 2026

MY means the yearly maximum for this service has been exceeded for the patient. Check the code's limit and what was paid.

What it means

MY means the yearly maximum for the service has been exceeded. Services past the limit are not paid.

Under the Schedule's rules (GP7), a maximum with a time period is counted per patient in date order. Check whether the limit is per calendar year or per 12 months, as each listing says.

Common causes

  • The same service was billed more often than the yearly limit allows
  • Another physician's claims counted toward a limit shared by all physicians

How to fix it

  1. Check the fee code's yearly limit in the Schedule of Benefits.
  2. Count the services paid for the patient in that 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 yearly 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: M4, M5, MD, MC

Sources