CARCs explain why a claim or line was paid differently than billed. RARCs add detail about what to do next. Together with a group code, they are the language every remittance uses. Learn to read them and most denials tell you their own fix.
Step-by-step fixes for the most-searched codesCO-22: find the primary payer · CO-96 / PR-96: non-covered · CO-4: modifier fixes · OA-23: secondary paid $0 · PR-204: plan exclusion · CO-29: timely filing · CO-109: wrong payer
1. CARC and RARC code lookup
Search all 297 active CARC codes and the 166 RARCs billers see most. Type a code (227, CO-16, N425, MA130) or a word (duplicate, authorization, modifier).
Showing all 463 codes
| Code | What it means | Usual next step |
|---|---|---|
| 1CARC | The patient's deductible applies, so this amount is owed by the patient. | Bill the patient or secondary payer for the deductible amount. PR-1 guide |
| 2CARC | This is the patient's coinsurance share under their plan. | Bill the patient or secondary payer for the coinsurance. |
| 3CARC | This is the patient's copay amount under their plan. | Collect the copay from the patient or bill the secondary payer. |
| 4CARC | The modifier billed does not fit the procedure code. | Review coding and send a corrected claim with the right modifier. CO-4 guide |
| 5CARC | The procedure code or bill type does not match the place of service billed. | Confirm where service occurred and correct the POS or bill type. |
| 6CARC | The procedure or revenue code does not fit the patient's age. | Verify date of birth and code; correct demographics or coding and rebill. |
| 7CARC | The procedure or revenue code does not fit the patient's gender on file. | Verify patient gender with payer; correct coding or add a gender modifier. |
| 8CARC | The procedure is not allowed for the billing provider's specialty or taxonomy. | Check the taxonomy on the claim and payer enrollment; correct and rebill. |
| 9CARC | The diagnosis code does not fit the patient's age. | Verify date of birth and diagnosis code; correct and resubmit. |
| 10CARC | The diagnosis code does not fit the patient's gender on file. | Verify patient gender and diagnosis code; correct and resubmit. |
| 11CARC | The diagnosis billed does not support the procedure performed. | Review documentation and payer policy; fix diagnosis linkage and rebill. |
| 12CARC | The diagnosis is not appropriate for the type of provider billing. | Verify the diagnosis and provider taxonomy; correct and resubmit. |
| 13CARC | The payer shows the patient died before the date of service. | Verify date of death and service date; correct the record or appeal. |
| 14CARC | The patient's date of birth on file is after the date of service. | Correct the date of birth or service date and resubmit. |
| 16CARC | The claim is missing information or has a billing error; remark codes explain what. | Read the RARC, fix the missing or wrong data, and resubmit. CO-16 guide |
| 18CARC | This claim or service line exactly duplicates one already received. | Check original claim status; do not rebill unless it was denied or lost. |
| 19CARC | The payer says this is a work-related injury, so workers' comp is responsible. | Bill the workers' comp carrier, or document that the injury is not work-related. |
| 20CARC | The payer says a liability insurer should cover this injury. | Get accident and carrier details from the patient and bill the liability carrier. |
| 21CARC | The payer says a no-fault (auto) insurer is responsible for this injury. | Bill the no-fault carrier first, then send its EOB to this payer. |
| 22CARC | Another payer may be primary under coordination of benefits rules. | Confirm other coverage with the patient and bill the primary payer first. CO-22 guide |
| 23CARC | Shows the effect of payments or adjustments already made by a prior payer. | Reconcile against the primary EOB; bill any remaining balance appropriately. OA-23 guide |
| 24CARC | The charges are covered under a capitation or managed care arrangement. | Write off per the capitation contract; do not bill the patient. |
| 26CARC | The service happened before the patient's coverage started. | Verify eligibility dates; bill the correct payer or the patient. |
| 27CARC | The service happened after the patient's coverage ended. | Verify eligibility dates; bill the new payer or the patient. |
| 29CARC | The payer's deadline for submitting this claim has passed. | Find proof of timely filing and appeal; otherwise write off. CO-29 guide |
| 31CARC | The payer cannot match the patient to any of its members. | Verify member ID, name, and DOB with the patient's card; correct and rebill. |
| 32CARC | The payer shows the patient is not an eligible dependent on the policy. | Confirm dependent status with the subscriber; bill the correct payer or patient. |
| 33CARC | The subscriber's policy does not include dependent coverage. | Ask the patient for other coverage; bill another payer or the patient. |
| 34CARC | The subscriber's policy does not cover newborns. | Check whether the newborn has been added or has other coverage; bill accordingly. |
| 35CARC | The patient has used up the plan's lifetime benefit maximum. | Bill any secondary payer, then the patient. |
| 39CARC | The payer denied the service when authorization or precertification was requested. | Appeal with clinical support, or bill the patient if a waiver was signed. |
| 40CARC | The payer says the charges do not qualify as emergency or urgent care. | Review documentation and diagnosis; appeal with records supporting the emergency. |
| 44CARC | The payer took a discount for prompt payment. | Post the adjustment; confirm the discount is allowed by contract. |
| 45CARC | The charge is higher than the fee schedule or contracted rate allowed. | Write off per contract; check the allowed amount is correct. CO-45 guide |
| 49CARC | Routine or preventive exams, and screenings done with them, are not covered. | Check plan preventive benefits; bill the patient if they agreed to pay. |
| 50CARC | The payer does not consider the service medically necessary. | Review payer policy and documentation; appeal with records or bill per ABN. CO-50 guide |
| 51CARC | The service is not covered because it relates to a pre-existing condition. | Verify plan terms; appeal if exclusion does not apply, or bill the patient. |
| 53CARC | Services by a close relative or household member are not covered. | Confirm the provider relationship; write off or bill per plan rules. |
| 54CARC | The payer does not cover more than one physician or assistant for this service. | Check assistant-surgeon rules; appeal with documentation or write off. |
| 55CARC | The payer considers the procedure, treatment, or drug experimental or investigational. | Appeal with clinical evidence, or bill the patient if they signed a waiver. |
| 56CARC | The payer does not consider the treatment proven to be effective. | Appeal with supporting clinical literature or bill per patient waiver. |
| 58CARC | The payer says the service was given in an inappropriate place of service. | Verify the POS code; correct it or appeal with documentation. |
| 59CARC | Payment was reduced under multiple or concurrent procedure rules. | Confirm modifiers and procedure order; appeal only if the reduction was misapplied. |
| 60CARC | Outpatient services close to an inpatient stay are not paid separately. | Check payment window rules; bundle onto the inpatient claim if required. |
| 61CARC | Payment was reduced because a required second surgical opinion was not obtained. | Submit proof of the second opinion if obtained; otherwise write off per contract. |
| 66CARC | This is the patient's blood deductible amount. | Bill the patient or secondary payer for the blood deductible. |
| 69CARC | Adjustment for a day outlier on an inpatient claim. | Post the adjustment; verify against the payer's outlier calculation. |
| 70CARC | Cost outlier adjustment to pay for unusually high costs. | Post the adjustment; verify the outlier payment calculation. |
| 74CARC | Indirect medical education (IME) adjustment. | Post the adjustment; no action needed unless the amount looks wrong. |
| 75CARC | Direct medical education adjustment. | Post the adjustment; no action needed unless the amount looks wrong. |
| 76CARC | Disproportionate share (DSH) adjustment. | Post the adjustment; no action needed unless the amount looks wrong. |
| 78CARC | Adjustment for non-covered days or room charges. | Review covered days and room type; bill the patient or appeal if covered. |
| 85CARC | Interest charged to the patient. | Post as patient responsibility; follow up with the patient. |
| 89CARC | Professional fees were taken out of the charges. | Bill professional services separately on a professional claim. |
| 90CARC | Adjustment to the drug ingredient cost (pharmacy claims only). | Verify NDC, quantity, and pricing; write off per contract. |
| 91CARC | Adjustment to the pharmacy dispensing fee. | Write off per contract; check the dispensing fee rate. |
| 94CARC | The payer paid more than the billed charges. | Verify the payment; refund or adjust if overpaid in error. |
| 95CARC | The patient or provider did not follow plan procedures. | Read remark codes to see which rule was missed; correct and appeal. |
| 96CARC | The charge is not covered; remark codes explain why. | Check the RARC and plan benefits; bill the patient or appeal. CO-96 guide |
| 97CARC | This service is bundled into payment for another service already processed. | Check NCCI edits; add a modifier if separately payable, otherwise write off. CO-97 guide |
| 100CARC | The payer sent the payment to the patient or subscriber, not the provider. | Collect the payment from the patient. |
| 101CARC | Predetermination: estimated payment once services are done or claim is processed. | Use as an estimate; submit the actual claim after service. |
| 102CARC | Major medical adjustment. | Post the adjustment; check for patient balance under major medical. |
| 103CARC | A provider promotional discount, such as a senior discount, was applied. | Post the discount; confirm it matches your discount policy. |
| 104CARC | The managed care plan withheld part of the payment. | Track the withhold; reconcile at the plan's settlement period. |
| 105CARC | Tax was withheld from the payment. | Post the withholding; reconcile with tax records. |
| 106CARC | The patient's payment option or election was not in effect. | Verify the patient's election with the payer; bill the patient if applicable. |
| 107CARC | The related or qualifying claim or service was not found on this claim. | Add the qualifying service or reference the related claim and rebill. |
| 108CARC | DME rental or purchase guidelines were not met. | Review rent-versus-purchase rules; correct modifiers and rebill. |
| 109CARC | This payer does not cover the claim; it must go to a different payer or contractor. | Identify the correct payer or MAC and submit the claim there. CO-109 guide |
| 110CARC | The claim was billed before the date of service. | Wait until services are complete, then resubmit with correct dates. |
| 111CARC | The service is covered only if the provider accepts assignment. | Rebill with assignment accepted, or bill the patient if non-assigned. |
| 112CARC | The service was not given directly to the patient or was not documented. | Gather documentation proving direct service and appeal, or write off. |
| 114CARC | The procedure or product does not have FDA approval. | Verify FDA status; bill the patient if they agreed in writing. |
| 115CARC | The procedure was postponed, canceled, or delayed. | Confirm the service was done; rebill with correct date or void. |
| 116CARC | The patient's signed advance notice (such as an ABN) did not meet requirements. | Write off; fix ABN forms and process for future cases. |
| 117CARC | Transport is covered only to the nearest facility able to give needed care. | Write off extra mileage, or appeal showing nearer facilities could not provide the care. |
| 118CARC | ESRD network support adjustment. | Post the adjustment; no action needed. |
| 119CARC | The benefit maximum for this period or occurrence has been reached. | Verify benefit usage; bill secondary payer or patient. |
| 121CARC | Indemnification adjustment that offsets an outstanding member balance. | Post the adjustment; reconcile the patient balance. |
| 122CARC | Payment was reduced under psychiatric benefit limits. | Check behavioral health benefits; bill the patient or secondary payer. |
| 128CARC | The newborn's services are included in the mother's payment. | Bill under the mother's claim; do not bill separately. |
| 129CARC | Earlier processing information appears to be wrong; remark codes explain. | Read the RARC, correct prior payer data, and resubmit. |
| 130CARC | A claim submission fee was deducted. | Post the fee; check contract terms on submission fees. |
| 131CARC | A negotiated discount specific to this claim was applied. | Write off per the negotiated agreement. |
| 132CARC | Adjustment for a prearranged demonstration project. | Post the adjustment per the demonstration project terms. |
| 133CARC | This service line is pending further review by the payer. | Wait for final adjudication; follow up if not resolved in 30 days. |
| 134CARC | Technical fees were taken out of the charges. | Bill the technical component separately to the correct entity. |
| 135CARC | The payer cannot process interim bills. | Hold and submit one final bill covering the full stay. |
| 136CARC | The prior payer's coverage rules were not followed. | Review primary payer requirements, fix the issue, and rebill. |
| 137CARC | Regulatory surcharge, assessment, allowance, or health-related tax. | Post the adjustment; no action needed. |
| 139CARC | Funding agreement adjustment because the subscriber works for the provider. | Write off per the employee funding agreement. |
| 140CARC | The patient's ID number and name do not match payer records. | Verify the member ID and name from the card; correct and rebill. |
| 142CARC | The patient's monthly Medicaid liability (share of cost) amount. | Collect the share of cost from the patient. |
| 143CARC | Part of the payment has been deferred. | Track the deferred amount and follow up for later payment. |
| 144CARC | Incentive adjustment, such as for a preferred product or service. | Post the incentive adjustment; no action needed. |
| 146CARC | The diagnosis code was not valid on the date of service. | Update to a diagnosis code valid for that date and resubmit. |
| 147CARC | The provider's contracted rate has expired or is not on file with the payer. | Contact provider relations to update the contract rate, then reprocess. |
| 148CARC | Information from another provider was missing or incomplete. | Get the needed records from the other provider and resubmit. |
| 149CARC | The lifetime maximum for this benefit category has been reached. | Bill any secondary payer, then the patient. |
| 150CARC | The payer says the documentation does not justify the level of service billed. | Review documentation; appeal with records or rebill the level the notes support. |
| 151CARC | The payer says the records do not justify the number or frequency of services billed. | Check frequency limits; appeal with supporting records or adjust units. |
| 152CARC | The payer says the records do not justify the length or duration of service billed. | Review time documentation and policy limits; appeal with records if supported. |
| 153CARC | The payer says the records do not justify the dosage billed. | Verify dose and units against the order and policy; correct or appeal. |
| 154CARC | The payer says the records do not justify the days' supply billed. | Confirm days' supply on the prescription; correct the claim or appeal. |
| 155CARC | The patient declined the service or procedure. | Confirm with the clinic; remove the line or correct the claim if performed. |
| 157CARC | The service was needed because of an act of war, which the plan excludes. | Verify the cause of injury; appeal if wrongly coded or bill another source. |
| 158CARC | The service was performed outside the US, which the plan does not cover. | Confirm place of service; bill the patient or travel coverage if applicable. |
| 159CARC | The service was needed because of terrorism, which the plan excludes. | Verify the injury cause; appeal if incorrect or seek other coverage. |
| 160CARC | The injury or illness came from an activity the plan specifically excludes. | Review accident details; appeal if misclassified, otherwise bill the patient. |
| 161CARC | An adjustment reflecting a provider performance or incentive bonus payment. | No action needed; reconcile the bonus amount in your payment posting. |
| 163CARC | An attachment or document mentioned on the claim never arrived at the payer. | Send the referenced attachment with the claim number, or resubmit with it. |
| 164CARC | The attachment or document mentioned on the claim arrived too late. | Check payer deadlines; resend promptly or appeal with proof of timely sending. |
| 166CARC | The services were billed after this payer's responsibility under the plan had ended. | Identify the payer responsible on the service date and bill them. |
| 167CARC | The payer does not cover the diagnosis or diagnoses billed. | Verify diagnosis coding; correct if wrong, or bill patient if ABN on file. |
| 169CARC | The payer paid for an alternative benefit instead of the service billed. | Review the alternate benefit paid; bill the patient the difference if allowed. |
| 170CARC | The service is not payable when this type of provider performs or bills it. | Check provider type rules; rebill under an eligible provider if appropriate. |
| 171CARC | The service is not payable for this provider type in this kind of facility. | Verify provider type and place of service; correct the claim or appeal. |
| 172CARC | Payment was reduced because of the billing provider's specialty. | Confirm specialty enrollment with the payer; update credentialing or appeal. |
| 173CARC | The service or equipment did not have a physician's prescription. | Obtain the physician order and resubmit or appeal with it attached. |
| 174CARC | The service was not ordered before it was delivered. | Get documentation of a prior order; appeal if it existed before service. |
| 175CARC | The prescription is missing required elements. | Obtain a complete prescription from the prescriber and resubmit. |
| 176CARC | The prescription had expired or was outdated on the service date. | Obtain a current prescription and resubmit for covered dates. |
| 177CARC | The patient does not meet the plan's eligibility requirements. | Verify eligibility; bill the correct payer or the patient. |
| 178CARC | The patient has not met the required Medicaid spend down amount. | Bill the patient for the spend down amount; rebill once it is met. |
| 179CARC | The patient has not completed the plan's required waiting period. | Confirm waiting period dates; bill the patient or rebill after it ends. |
| 180CARC | The patient does not meet the plan's residency requirements. | Verify the patient's address and coverage; bill the correct payer. |
| 181CARC | The procedure code was not valid on the date of service. | Check the code set for that date; correct the code and resubmit. |
| 182CARC | The modifier was not valid on the date of service. | Verify modifier validity for that date; send a corrected claim. |
| 183CARC | The referring provider is not eligible to refer this service. | Verify the referring provider's enrollment; correct the referring NPI and rebill. |
| 184CARC | The ordering or prescribing provider is not eligible to order this service. | Verify the ordering provider's enrollment; correct the ordering NPI and rebill. |
| 185CARC | The rendering provider is not eligible to perform the billed service. | Check rendering provider credentialing and scope; rebill under an eligible provider. |
| 186CARC | Payment was adjusted because the patient's level of care changed. | Review level of care dates; confirm billing matches each level. |
| 187CARC | The amount was paid from a patient spending account such as an FSA, HSA, or HRA. | Post the spending account payment; bill the patient any remaining balance. |
| 188CARC | The product or procedure is covered only when used per FDA guidance. | Check FDA labeling and documentation; appeal if use was on-label. |
| 189CARC | An unlisted or NOC code was billed when a specific code exists. | Replace the unlisted code with the specific CPT/HCPCS code and resubmit. |
| 190CARC | Payment is bundled into the allowance for a qualified SNF stay. | Do not bill separately; bill the SNF under consolidated billing if applicable. |
| 192CARC | A nonstandard adjustment code from a paper remittance, used when passing COB data. | Review the original paper remit; report correctly to the secondary payer. |
| 193CARC | After review, the payer is upholding its original payment decision. | Consider the next appeal level with stronger documentation, or close it. |
| 194CARC | Anesthesia was performed by the surgeon, assistant surgeon, or attending physician. | Anesthesia is not separately payable here; review billing and write off if correct. |
| 195CARC | A refund was issued to a payer that wrongly paid as primary. | Reconcile the refund and bill the correct primary payer. |
| 197CARC | The required precertification, authorization, or notification was not obtained. | Check for an auth; appeal with it, or request a retro authorization. CO-197 guide |
| 198CARC | The services exceeded what the precertification or authorization approved. | Request an auth extension or update; appeal for the extra units or days. |
| 199CARC | The revenue code and procedure code do not match. | Correct the revenue code or HCPCS pairing and resubmit. |
| 200CARC | The expenses occurred while the patient's coverage had lapsed. | Verify coverage dates; bill another payer or the patient. |
| 201CARC | The patient owes this amount under a set aside or similar agreement. | Bill the patient or the set aside arrangement per the remark codes. |
| 202CARC | The plan does not cover personal comfort or convenience items. | Bill the patient if properly notified; otherwise write off. |
| 203CARC | Payment was adjusted because the service was discontinued or reduced. | Verify the correct modifier (52, 53, 73, 74) and documentation. |
| 204CARC | The patient's current benefit plan does not cover this service, item, or drug. | Verify benefits; bill the patient if allowed or bill another payer. PR-204 guide |
| 205CARC | A processing fee for a pharmacy discount card transaction. | Post as an adjustment; no further action needed. |
| 206CARC | The National Provider Identifier is missing. | Add the required NPI and resubmit the claim. |
| 207CARC | The National Provider Identifier is in an invalid format. | Correct the NPI to a valid 10 digit number and resubmit. |
| 208CARC | The National Provider Identifier does not match the payer's records. | Confirm the NPI on file with the payer; correct enrollment or the claim. |
| 209CARC | Per regulation or agreement, the patient cannot be billed, but a later payer can be. | Do not bill the patient; bill the secondary payer and refund if collected. |
| 210CARC | The precertification or authorization was not obtained in time. | Appeal with proof of timely request or any extenuating circumstances. |
| 211CARC | Drugs with NDCs not eligible for manufacturer rebate are not covered. | Verify the NDC is rebate eligible; use a covered NDC or bill the patient. |
| 212CARC | Administrative surcharges are not covered. | Write off the surcharge; do not bill it to this payer. |
| 213CARC | The service violates physician self referral (Stark) rules or payer policy. | Review the referral relationship with compliance before rebilling or appealing. |
| 215CARC | Adjusted based on subrogation of a third party settlement. | Pursue the liable third party or settlement; reconcile any recovery. |
| 216CARC | Adjusted based on findings from a review organization or the payer's own review. | Review the findings; appeal with documentation if you disagree. |
| 219CARC | Adjusted based on the extent of the injury, usually in workers' comp. | Review the jurisdictional rules cited; appeal if treatment relates to the injury. |
| 222CARC | The provider exceeded its contracted maximum hours, days, or units for the period. | Check contract limits and unit counts; appeal if the cap was not reached. |
| 223CARC | Adjustment required by a federal, state, or local law not covered by another code. | Review the remark codes for the law cited; adjust or appeal accordingly. |
| 224CARC | The patient's identity may be compromised by identity theft; verification is required. | Verify the patient's identity and send the payer the required proof. |
| 225CARC | A penalty or interest payment by the payer, used in plan to plan encounter reports. | Post as an informational adjustment; no billing action needed. |
| 226CARC | Information requested from the billing or rendering provider was missing, late, or incomplete. | Check remark codes, send the requested records, and request reprocessing. |
| 227CARC | Information requested from the patient or insured was missing or incomplete. | Ask the patient to respond to the payer, then request reprocessing. |
| 228CARC | Denied because requested information was not supplied to a previous payer. | Send the information to the prior payer, then rebill this payer with its EOB. |
| 229CARC | Part of the charge was not considered by Medicare because the bill type was 12X. | Use when sending COB data; bill the secondary payer per their policy. |
| 231CARC | The procedures are mutually exclusive and cannot both be done the same day or setting. | Review NCCI edits; bill the correct code or add a modifier if supported. |
| 232CARC | A DRG amount difference because the patient was transferred between institutions. | Verify transfer details and discharge status; appeal if the code is wrong. |
| 233CARC | Charges tied to a hospital acquired condition or preventable medical error are not paid. | Review POA indicators and coding; correct if the condition was present on admission. |
| 234CARC | The procedure is not paid separately because it is bundled into another service. | Review bundling rules and remark codes; add a modifier only if supported. |
| 235CARC | An adjustment for sales tax. | Post the adjustment; bill the patient tax only if allowed. |
| 236CARC | The procedure or modifier combination conflicts with another same-day service under NCCI or state rules. | Check NCCI or state edits; correct codes or append an appropriate modifier. |
| 237CARC | A penalty required by law or regulation. | Review the remark codes for the penalty reason; fix the cause going forward. |
| 238CARC | The claim covers eligible and ineligible dates; this is the patient's share for the ineligible period. | Bill the patient for the ineligible period, or another payer if covered. |
| 239CARC | The claim covers both eligible and ineligible coverage dates and must be split. | Split into separate claims by coverage period and rebill. |
| 240CARC | The diagnosis does not fit the patient's recorded birth weight. | Verify birth weight and diagnosis coding; send a corrected claim. |
| 241CARC | The Low Income Subsidy (LIS) copay amount for the patient. | Collect the LIS copay from the patient or bill as applicable. |
| 242CARC | The services were not provided by a network or primary care provider. | Check network status; request out of network exception or bill patient. |
| 243CARC | The services were not authorized by a network or primary care provider. | Obtain the PCP referral or authorization and appeal or rebill. |
| 245CARC | Part of the payment was withheld under a provider performance program. | Post as contractual withhold; track for possible year-end reconciliation. |
| 246CARC | This code is not payable and is reported only for required reporting. | No action needed; it is informational. |
| 247CARC | Deductible for a professional service done in an institutional setting and billed on an institutional claim. | Bill the patient or secondary payer for the deductible. |
| 248CARC | Coinsurance for a professional service done in an institutional setting and billed on an institutional claim. | Bill the patient or secondary payer for the coinsurance. |
| 249CARC | The payer has identified this claim as a hospital readmission. | Review readmission criteria; combine stays or appeal if unrelated. |
| 250CARC | The attachment received was the wrong document; the needed one is still missing. | Check remark codes and send the correct attachment referencing the claim. |
| 251CARC | The attachment received was incomplete or deficient; more information is needed. | Send the complete documentation identified in the remark codes. |
| 252CARC | The payer needs an attachment or other documentation to process this claim. | Send the documentation listed in the remark codes with the claim number. |
| 253CARC | A federal payment reduction due to sequestration. | Write off; do not bill the patient for this amount. |
| 254CARC | The dental plan received the claim but it is not covered; send it to the medical plan. | Bill the patient's medical plan for these services. |
| 256CARC | The service is not payable under the managed care contract. | Review your managed care contract terms; appeal or write off. |
| 257CARC | Payment is on hold during the exchange premium grace period and will be finalized later. | Wait for the grace period to end; then bill the patient if coverage terminated. |
| 258CARC | Not covered while the patient is in custody or incarcerated. | Bill the responsible correctional or government authority. |
| 259CARC | An additional payment for dental or vision service use. | Post the additional payment; no action needed. |
| 260CARC | The claim was processed under the Medicaid ACA enhanced fee schedule. | Post per the enhanced fee schedule; verify the rate paid. |
| 261CARC | The procedure or service does not fit the patient's history. | Review the patient's history and documentation; appeal with supporting records. |
| 262CARC | An adjustment for drug delivery cost, used for pharmaceuticals. | Post the adjustment; verify delivery charges are billable per contract. |
| 263CARC | An adjustment for drug shipping cost, used for pharmaceuticals. | Post the adjustment; verify shipping charges are billable per contract. |
| 264CARC | Pharmacy claim adjusted for the cost of postage or shipping. | Write off per the pharmacy contract; confirm the shipping allowance terms. |
| 265CARC | Pharmacy claim adjusted for an administrative fee. | Reconcile against the pharmacy contract and write off if the fee is valid. |
| 266CARC | Pharmacy claim adjusted for the cost of preparing a compounded drug. | Check compound pricing terms; appeal with ingredient detail if underpaid. |
| 267CARC | The claim or service covers more than one month; see the remark code for details. | Split the claim by month per payer rules and resubmit. |
| 268CARC | The claim crosses two calendar years and must be split. | Resubmit as separate claims, one for each calendar year. |
| 269CARC | Anesthesia is not covered when provided with this particular service or procedure. | Review payer anesthesia policy; appeal with documentation if anesthesia was required. |
| 270CARC | The medical plan does not cover these services; they belong under the patient's dental plan. | Bill the patient's dental plan for these services. |
| 271CARC | Reduction tied to a scheduled periodic payment where deferred amounts were already reported. | Reconcile against the contractual payment schedule; no rebill needed. |
| 272CARC | The payer's coverage or program guidelines for this service were not met. | Review the payer's policy criteria; appeal with supporting records if met. |
| 273CARC | The service went beyond the limits set by coverage or program guidelines. | Check benefit limits used; bill the patient if allowed or appeal. |
| 274CARC | Not payable because of the patient's care coordination arrangement. | Confirm the care coordination agreement terms; route to the coordinating provider if required. |
| 275CARC | This payer will not pick up cost-sharing left by the prior payer(s). | Bill the patient for the remaining deductible, coinsurance, or copay. |
| 276CARC | Because the prior payer denied these services, this payer will not cover them either. | Resolve the primary denial first, then resubmit to this payer. |
| 277CARC | Claim is on hold during the marketplace premium grace period and may be reversed later. | Wait for the grace period to end; monitor for reversal or payment. |
| 278CARC | Provider did not meet a performance program's proficiency requirements. | Review program requirements with the payer; correct enrollment or appeal. |
| 279CARC | Service came from a provider outside the patient's preferred or narrow network. | Verify the member's network; refer in-network or appeal with network exception. |
| 280CARC | The medical plan does not cover these services; they belong under the patient's pharmacy plan. | Bill the patient's pharmacy benefit plan. |
| 281CARC | The deductible was waived under the provider contract. | No patient billing for deductible; post as contractual adjustment. |
| 282CARC | The procedure or revenue code does not match the type of bill submitted. | Correct the bill type or revenue code and send a corrected claim. |
| 283CARC | The attending provider is not eligible to direct the patient's care. | Verify attending provider credentials; correct the attending on the claim. |
| 284CARC | The authorization number may be valid, but it does not cover the services billed. | Obtain authorization for the billed services or correct the auth number. |
| 285CARC | The appeal was not filed following the payer's required process. | Review payer appeal rules and refile using the correct procedure. |
| 286CARC | The appeal was filed after the payer's deadline. | Check the appeal deadline; send proof of timely filing if available. |
| 287CARC | Services went beyond what the referral allowed. | Request an updated or extended referral and resubmit. |
| 288CARC | A required referral was not on file. | Obtain the referral from the PCP and resubmit the claim. |
| 289CARC | Reviewed under both the dental and medical plans; no benefits available under either. | Confirm coverage with both plans; bill the patient if truly non-covered. |
| 290CARC | The dental plan does not cover this; the claim was sent on to the medical plan. | Monitor the medical plan for processing; no rebill needed yet. |
| 291CARC | The medical plan does not cover this; the claim was sent on to the dental plan. | Track the claim with the dental plan. |
| 292CARC | The medical plan does not cover this; the claim was sent on to the pharmacy plan. | Track the claim with the pharmacy benefit plan. |
| 293CARC | Payment for this service was issued to the employer. | Contact the employer to collect payment; update posting. |
| 294CARC | Payment for this service was issued to an attorney. | Contact the attorney's office to collect payment; update posting. |
| 295CARC | Adjustment for pharmacy direct or indirect remuneration (DIR) fees. | Reconcile DIR fees against the pharmacy contract. |
| 296CARC | The authorization number may be valid, but it was not issued for this provider. | Get authorization issued under the rendering provider, or correct provider info. |
| 297CARC | The medical plan does not cover these services; they belong under the patient's vision plan. | Bill the patient's vision plan for these services. |
| 298CARC | The medical plan does not cover this; the claim was sent on to the vision plan. | Track the claim with the vision plan. |
| 299CARC | The billing provider cannot be paid for the billed service. | Verify billing provider enrollment and eligibility; correct the billing NPI. |
| 300CARC | The medical plan does not cover this; the claim was sent on to the behavioral health plan. | Track the claim with the behavioral health plan. |
| 301CARC | The medical plan does not cover these services; they belong under the behavioral health plan. | Bill the patient's behavioral health plan or carve-out vendor. |
| 302CARC | The authorization or notification was obtained too late or has expired. | Request a retro or new authorization, then resubmit or appeal. |
| 303CARC | Prior payer cost-sharing is not covered for dual-eligible QMB patients; cannot bill them. | Write off; do not bill QMB patients for cost-sharing. |
| 304CARC | The medical plan does not cover these services; they belong under the patient's hearing plan. | Bill the patient's hearing plan for these services. |
| 305CARC | The medical plan does not cover this; the claim was sent on to the hearing plan. | Track the claim with the hearing plan. |
| 306CARC | The type of bill does not match the patient discharge status. | Correct the bill type or patient status code and resubmit. |
| 307CARC | Medicare refund adjustment under the negotiated drug Maximum Fair Price program. | Review the remark code and reconcile the Maximum Fair Price refund. |
| 308CARC | Payment changed due to a funding agreement between payer and provider. | Reconcile against the funding agreement terms; write off as contracted. |
| A0CARC | Amount refunded to the patient. | Post the patient refund and adjust the patient balance. |
| A1CARC | Claim or service denied; the remark code gives the specific reason. | Read the remark code and fix the issue it identifies. |
| A5CARC | Medicare PPS capital cost outlier payment amount. | Informational; post the outlier amount and verify the calculation. |
| A6CARC | The required prior hospital stay or 30-day transfer rule was not met. | Verify qualifying stay dates; appeal with records if the requirement was met. |
| A8CARC | The claim could not be assigned to a DRG. | Review diagnosis, procedure, and discharge data; correct and resubmit. |
| B1CARC | The visits billed are not covered. | Check visit limits and benefits; bill the patient if allowed. |
| B4CARC | Payment reduced as a penalty for filing late. | Write off the penalty; review filing workflow to prevent recurrence. |
| B7CARC | Provider was not certified or eligible to be paid for this service on this date. | Verify provider enrollment and certification dates; update and resubmit. |
| B8CARC | A different service was available and should have been used instead. | Review payer policy; appeal with documentation supporting the service chosen. |
| B9CARC | The patient is enrolled in hospice. | Bill hospice for related care; use the right modifier for unrelated services. |
| B10CARC | Allowance cut because part of the basic procedure or test was already paid. | Check for unbundling; write off the reduction, do not bill the patient beyond limit. |
| B11CARC | This payer does not cover it and has sent the claim to the correct payer. | Follow up with the payer the claim was transferred to. |
| B12CARC | The services are not documented in the patient's medical record. | Obtain complete documentation and appeal, or write off if undocumented. |
| B13CARC | This claim or service may already have been paid in an earlier payment. | Check prior remits for payment; appeal if no payment was received. |
| B14CARC | Only one visit or consult per physician per day is covered. | Combine services into one visit or appeal with a modifier if distinct. |
| B15CARC | A required qualifying service has not been received or processed yet. | Submit the qualifying service claim first, then rebill this one. |
| B16CARC | The patient did not meet the requirements to be billed as a new patient. | Rebill with the established patient E/M code. |
| B20CARC | Another provider already furnished all or part of this service. | Verify who performed the service; appeal with documentation or write off. |
| B22CARC | Payment was adjusted based on the diagnosis billed. | Review diagnosis coding; send a corrected claim if the diagnosis was wrong. |
| B23CARC | The lab's CLIA certification does not allow it to bill this test. | Verify CLIA certificate level and number; update enrollment before rebilling. |
| P1CARC | Property and casualty adjustment required by state rules; see the remark code. | Review the remark code and state rules; appeal if applied incorrectly. |
| P2CARC | Workers' comp says the injury or illness is not work related. | Bill the patient's health insurance instead. |
| P3CARC | Workers' comp case settled; the patient owes this via a set-aside or agreement. | Bill the patient or the set-aside account. |
| P4CARC | Workers' comp found the claim non-compensable; this payer is not liable. | Bill the patient's health insurance or the patient. |
| P5CARC | Paid at the payer's reasonable and customary rate; no legislated fee schedule applies. | Review the allowed amount; appeal if below usual rates. |
| P6CARC | Adjusted based on the patient's entitlement to benefits. | Verify benefit entitlement with the carrier; appeal if incorrect. |
| P7CARC | The billed code is not in the applicable fee schedule. | Resubmit with a valid fee schedule code and supporting documentation. |
| P8CARC | The claim is under investigation by the payer. | Monitor and follow up with the adjuster; hold patient billing. |
| P9CARC | No CPT or HCPCS code exists that describes this service. | Contact the carrier for billing guidance; use an unlisted code with records. |
| P10CARC | Payment reduced to zero due to ongoing litigation. | Hold the account and follow up after the litigation concludes. |
| P11CARC | The related injury claim is pending because of litigation. | Hold the account and track the litigation outcome. |
| P12CARC | Adjusted to the state workers' comp fee schedule. | Write off the difference; verify the fee schedule amount applied. |
| P13CARC | Reduced or denied under workers' comp state rules or payment policies. | Review state rules cited; appeal with documentation if misapplied. |
| P14CARC | This service is included in payment for another service done the same day. | Check bundling rules; appeal with a modifier if separately payable. |
| P15CARC | Adjusted under the workers' comp medical treatment guidelines. | Review the treatment guidelines; appeal with clinical justification. |
| P16CARC | Provider is not authorized to treat injured workers in this state. | Complete state workers' comp provider certification, then resubmit. |
| P17CARC | The referral was not authorized by the attending physician as required. | Obtain the attending physician's referral and resubmit. |
| P18CARC | Code not on the state fee schedule; paid at a comparable service rate. | Verify the comparable allowance; appeal with documentation if too low. |
| P19CARC | The procedure has a zero relative value on the state fee schedule; nothing is payable. | Write off; confirm the code is correct for the service. |
| P20CARC | Service not payable under the state outpatient facility fee schedule. | Review the state facility fee schedule; correct billing or write off. |
| P21CARC | Denied under state auto MedPay or PIP rules or payment policies. | Bill the patient's health insurance; review PIP exhaustion or denial details. |
| P22CARC | Adjusted under state auto MedPay or PIP rules or payment policies. | Write off the adjustment or bill secondary coverage as allowed. |
| P23CARC | Adjusted to the state MedPay or PIP fee schedule. | Write off the difference; verify the fee schedule amount. |
| P24CARC | Property and casualty payment adjusted under a PPO agreement. | Write off per the PPO contract; confirm the network applies. |
| P25CARC | Payment adjusted under a workers' comp Medical Provider Network (MPN). | Write off per the MPN agreement; confirm network participation. |
| P26CARC | Payment adjusted under a Voluntary Provider Network (VPN). | Write off per the VPN agreement; confirm network participation. |
| P27CARC | Denied under state liability coverage rules or payment policies. | Bill the patient's health insurance or the patient. |
| P28CARC | Adjusted under state liability coverage rules or payment policies. | Write off the adjustment or bill other coverage as allowed. |
| P29CARC | Adjusted to the state liability benefits fee schedule. | Write off the difference; verify the fee schedule amount. |
| P30CARC | Exacerbation treatment denied because supporting documents were incomplete. | Send complete documentation of the exacerbation and appeal. |
| P31CARC | Exacerbation treatment denied because it went past the allowed time frame. | Appeal with clinical justification or bill other coverage. |
| P32CARC | Payment adjusted because liability was apportioned. | Bill the remaining share to other liable parties or coverage. |
| M2RARC | Service is not paid separately because the patient was an inpatient at the time. | Check inpatient dates; bill the hospital under arrangement or correct dates if wrong. |
| M15RARC | Separately billed tests or services were bundled as parts of one procedure; no separate payment. | Review NCCI edits; append a modifier like 59 or XU only if documentation supports it. |
| M20RARC | The HCPCS code is missing, incomplete, or not valid. | Verify the HCPCS code is valid for the date of service and resubmit a corrected claim. |
| M25RARC | Documentation does not support the level of service billed; payment reduced or denied. | Review notes against the billed level; appeal with records or check for a signed ABN. |
| M27RARC | Patient is held not liable under limitation of liability; provider must absorb the charges. | Do not bill the patient; appeal within 120 days if you believe due care was used. |
| M38RARC | Patient signed an advance notice before service and agreed to pay, so the patient is liable. | Bill the patient per the signed ABN; keep the ABN on file. |
| M39RARC | Patient is not liable because the advance notice you gave did not meet program rules. | Write off the charge; fix ABN form, timing, and wording for future patients. |
| M51RARC | The procedure code on the claim is missing, incomplete, or not valid. | Correct the CPT or HCPCS code for the date of service and resubmit. |
| M53RARC | Days or units of service are missing, incomplete, or not valid. | Check units against documentation and code definitions, then send a corrected claim. |
| M54RARC | Total charges on the claim are missing, incomplete, or not valid. | Confirm line charges add up to the claim total and resubmit. |
| M56RARC | The payer identifier is missing, incomplete, or not valid. | Verify the payer ID with your clearinghouse and resubmit to the correct payer. |
| M59RARC | The 'to' (end) date of service is missing, incomplete, or not valid. | Correct the service end date on the line or claim and resubmit. |
| M60RARC | The required Certificate of Medical Necessity (CMN) was not received. | Obtain a signed CMN from the ordering physician and resubmit with it. |
| M62RARC | The treatment authorization number is missing, incomplete, or not valid. | Get the correct prior auth number from the payer portal and add it to the claim. |
| M64RARC | A secondary diagnosis code is missing, incomplete, or not valid. | Review secondary ICD-10 codes for validity and specificity, then resubmit. |
| M76RARC | The diagnosis code is missing, incomplete, or not valid for this service. | Verify ICD-10 codes are valid, specific, and support the service; correct and resubmit. |
| M77RARC | Place of service code is missing, invalid, or does not fit the service billed. | Confirm where the service happened and correct the POS code on the claim. |
| M79RARC | The charge amount is missing, incomplete, or not valid. | Enter the correct charge for each line and resubmit. |
| M80RARC | Not covered when done on the same day or session as a service already processed. | Check NCCI and same-day rules; use a modifier only if the service was truly distinct. |
| M81RARC | The diagnosis must be coded to the highest level of specificity available. | Recode the ICD-10 to the full required number of characters and resubmit. |
| M84RARC | Codes must be from the code set in effect on the date of service. | Replace deleted or future codes with codes valid on the service date. |
| M86RARC | Payer already paid for the same or a similar procedure within the allowed time frame. | Check prior claims and frequency limits; appeal with records if medically necessary. |
| M114RARC | Processed under DMEPOS Competitive Bidding Program or demonstration project rules. | Confirm you are a contract supplier for the item and area before billing. |
| M115RARC | Item denied because the supplier is not a contract supplier for this program. | Refer patient to a contract supplier or confirm your contract status for the item. |
| M117RARC | Service is only covered when billed on an electronic claim. | Resubmit the claim electronically through your clearinghouse. |
| M119RARC | The National Drug Code (NDC) is missing, invalid, deactivated, or withdrawn. | Verify the 11-digit NDC is active for the date of service and resubmit. |
| M123RARC | Drug name, strength, or dosage is missing, incomplete, or not valid. | Add complete drug name, strength, and dose to the claim and resubmit. |
| M127RARC | The patient's medical record for this service was not received. | Send the requested records with the claim or appeal, using the payer's cover sheet. |
| M136RARC | Missing or invalid indication that a physician supervised or evaluated the service. | Add supervising provider information and resubmit if supervision is documented. |
| M141RARC | The physician-certified plan of care is missing. | Get the signed and dated plan of care and send it to the payer. |
| M143RARC | The provider's license information needs to be updated with the payer. | Update license details with the payer or in enrollment, then resubmit. |
| M144RARC | Pre-op and post-op care is already included in the payment for the surgery. | Do not bill global period visits separately unless unrelated; use modifier 24 or 25 if supported. |
| MA01RARC | Informational: you may appeal this decision; Medicare appeals must be filed within 120 days. | If you disagree, file a redetermination within 120 days of the notice date. |
| MA04RARC | Secondary payment needs the primary payer's identity or payment details, which were missing or unreadable. | Attach the primary EOB or add primary payment data to the 837 and resubmit. CO-22 guide |
| MA07RARC | Informational: claim details were also sent to Medicaid for review. | Watch for the Medicaid payment; do not bill the patient until Medicaid processes. |
| MA13RARC | Informational: billing the patient for amounts not marked PR may bring penalties. | Bill the patient only for amounts under the PR group code. |
| MA18RARC | Informational: the claim was crossed over to the patient's supplemental insurer. | Wait for the supplemental payer to process; do not send a separate claim to them. |
| MA27RARC | The Medicare number or patient name on the claim is missing, incomplete, or not valid. | Verify the MBI and name exactly as on the Medicare card, then resubmit. |
| MA28RARC | Informational: a non-assigned provider gets this notice for information only, with no added appeal rights. | No action needed; the patient holds appeal rights on non-assigned claims. |
| MA30RARC | Type of bill code is missing, incomplete, or not valid. | Correct the type of bill on the UB-04 or 837I and resubmit. |
| MA36RARC | The patient name is missing, incomplete, or not valid. | Match the patient name to the insurance card and resubmit. |
| MA39RARC | The patient's sex is missing, incomplete, or not valid, or conflicts with the service. | Verify patient sex in registration and on file with the payer; correct and resubmit. |
| MA44RARC | Informational: no appeal rights because the decision is based on law. | Do not appeal; review whether the patient can be billed or write off. |
| MA61RARC | Social Security number is missing, incomplete, or not valid. | Verify the SSN or required ID in registration and resubmit. |
| MA63RARC | The principal diagnosis is missing, incomplete, or not valid. | Correct the principal ICD-10 code so it is valid and supports the service. |
| MA64RARC | Payer is third in line and needs payment information from both the primary and secondary payers. | Bill primary and secondary first, then send both EOBs or COB data to this payer. |
| MA65RARC | The admitting diagnosis is missing, incomplete, or not valid. | Add a valid admitting diagnosis on the institutional claim and resubmit. |
| MA66RARC | The principal procedure code is missing, incomplete, or not valid. | Correct the principal ICD-10-PCS or procedure code and resubmit. |
| MA67RARC | Informational: this is a correction to a claim processed earlier. | Post the adjustment against the original claim and reconcile the balance. |
| MA81RARC | The provider or supplier signature is missing, incomplete, or not valid. | Add the required signature or signature-on-file indicator and resubmit. |
| MA83RARC | Claim did not say whether this payer is primary or secondary. | Verify coverage order and fill in the payer responsibility sequence, then resubmit. |
| MA92RARC | Plan information for the patient's other insurance is missing. | Collect other insurance details from the patient and add them to the claim. |
| MA99RARC | Medigap insurer information is missing, incomplete, or not valid. | Add the correct Medigap payer ID and policy number, then resubmit. |
| MA100RARC | Date of current illness or symptoms is missing, incomplete, or not valid. | Add the onset or injury date from the record and resubmit. |
| MA110RARC | Claim does not say whether diagnostic tests were done by an outside entity. | Indicate purchased service status and resubmit the corrected claim. |
| MA114RARC | Information on where services were furnished is missing, incomplete, or not valid. | Add the correct service facility name, address, and NPI, then resubmit. |
| MA120RARC | The CLIA certification number is missing, incomplete, or not valid. | Add your CLIA number to the claim and confirm the test is on your certificate. |
| MA125RARC | By law for this program, the payment is considered payment in full. | Write off the remaining balance; do not bill the patient beyond PR amounts. |
| MA130RARC | Claim has missing or invalid information and is unprocessable, so no appeal rights apply. | Fix the error named in the other remark codes and submit a new claim, not an appeal. CO-16 guide |
| N1RARC | Informational: you may appeal in writing within the time limits in your contract or plan rules. | Check the payer's appeal deadline and process if you disagree with the decision. |
| N4RARC | The prior insurance carrier's EOB is missing, incomplete, or not valid. | Attach a complete primary EOB, or send COB data electronically, and resubmit. |
| N5RARC | Payer received an EOB from a prior payer but has no claim on file. | Submit the full claim along with the prior payer's EOB. |
| N8RARC | Previous payer denied the crossover claim and did not forward full claim data. | Submit the claim directly to this payer with the primary EOB. |
| N10RARC | Adjustment is based on a review by a medical advisor, peer reviewer, or manual review. | Request the review rationale and appeal with records if you disagree. |
| N19RARC | Procedure is considered incidental to the primary procedure and not paid separately. | Review bundling rules; appeal or use a modifier only if documentation supports a separate service. |
| N20RARC | Service is not payable together with another service on the same date. | Check NCCI and payer edits; apply a modifier if supported, otherwise write off. |
| N22RARC | Payer added or changed the procedure code to better match the services rendered. | Compare the new code to your documentation; appeal if the original code was correct. |
| N23RARC | Informational: patient's share may change due to coordination of benefits or benefit maximums. | Hold patient billing until other payers process and the final PR amount is known. |
| N30RARC | Patient is not eligible for this service. | Verify eligibility and benefits for the service date; bill the correct payer or patient. |
| N31RARC | The prescribing provider's identifier is missing, incomplete, or not valid. | Add the prescribing provider's NPI and resubmit. |
| N32RARC | Claim must be submitted by the provider who actually rendered the service. | Rebill under the rendering provider's NPI and enrollment. |
| N34RARC | Wrong claim form or format was used for this service. | Resubmit on the correct form, such as CMS-1500 vs UB-04, or 837P vs 837I. |
| N36RARC | Claim must meet the primary payer's processing rules before this payer will consider it. | Resolve the primary payer's denial or requirements, then resubmit with the primary EOB. |
| N45RARC | Payment is based on the amount that was authorized. | Compare paid units to the authorization; request an auth update if more was needed. |
| N47RARC | Claim overlaps with another inpatient stay on file. | Check admission and discharge dates; correct dates or coordinate with the facility. |
| N52RARC | Patient was not enrolled in your managed care plan on the date of service. | Verify plan enrollment and PCP assignment; bill the correct plan. |
| N54RARC | Claim details do not match the services that were pre-certified or authorized. | Compare codes, dates, units, and provider to the auth; correct the claim or update the auth. |
| N56RARC | Procedure code is not correct or valid for the services or date of service billed. | Verify the code matches the documentation and is valid on that date; correct and resubmit. |
| N65RARC | Payer cannot find a rate or code on file for this date of service or provider. | Confirm the code is on your fee schedule and contract; contact the payer to load it. |
| N70RARC | Consolidated billing applies; payment goes through the facility or agency responsible. | Bill the SNF or home health agency under arrangement instead of the payer. |
| N95RARC | This provider type or specialty is not allowed to bill this service. | Check the specialty on file with the payer; rebill under an eligible provider or update enrollment. |
| N104RARC | Claim is outside this contractor's jurisdiction. | Find the correct Medicare contractor for the service and submit the claim there. |
| N111RARC | Only duplicate issues can be appealed; this service was already billed and processed. | Check the original claim; correct or adjust that claim instead of rebilling. |
| N115RARC | Decision was based on a Local Coverage Determination (LCD) policy. | Read the LCD; check covered diagnoses, documentation, and ABN; appeal if criteria were met. |
| N117RARC | Payer allows this service only one time per patient lifetime. | Confirm prior history; bill the patient only if a valid ABN or waiver exists. |
| N122RARC | An add-on code cannot be paid without its primary code. | Bill the add-on with its required primary procedure on the same claim. |
| N129RARC | Patient is not eligible for this service because of age. | Verify the patient's date of birth and age limits; correct DOB or bill patient if allowed. |
| N130RARC | See the plan benefit documents for restrictions that apply to this service. | Review the plan's benefit limits or exclusions; appeal or bill patient per contract. |
| N155RARC | Informational: payer has no other insurance on file and asks for it. | Collect other coverage details from the patient and send them to the payer. |
| N174RARC | Service is not covered, but patient liability is limited to amounts shown as PR. | Bill the patient only the PR amount and write off the rest. |
| N179RARC | Payer asked the member for more information; claim will be reviewed once received. | Contact the patient to respond, such as an accident or other insurance questionnaire. |
| N180RARC | Item or service does not meet the criteria for the category it was billed under. | Review the billing category and coding rules; rebill under the correct category. |
| N185RARC | Informational: do not resubmit this claim or service. | Do not rebill; appeal or correct through the proper process if you disagree. |
| N192RARC | Informational: patient is a Medicaid or Qualified Medicare Beneficiary (QMB). | Do not bill the patient for Medicare cost sharing; bill Medicaid as secondary. |
| N202RARC | Informational: more details about this decision will be sent separately. | Watch for a separate letter before taking action. |
| N206RARC | Supporting documentation does not match what was reported on the claim. | Reconcile records and claim data; correct the claim or send corrected documentation. |
| N210RARC | Informational: you may appeal this decision. | Check the payer's appeal deadline and requirements if you disagree. |
| N211RARC | Informational: this decision cannot be appealed. | Do not appeal; correct and resubmit if an error caused the denial, or write off. |
| N216RARC | Payer does not cover this type of service, or patient is not enrolled in that benefit. | Verify the patient's benefit package; bill the correct carve-out plan or the patient. |
| N245RARC | Plan information for the other insurance is incomplete or not valid. | Correct the other payer's name, ID, and policy number, then resubmit. |
| N253RARC | The attending provider's NPI is missing, incomplete, or not valid. | Add the correct attending provider NPI and resubmit. |
| N255RARC | The billing provider taxonomy code is missing, incomplete, or not valid. | Add the taxonomy that matches the payer's enrollment record and resubmit. |
| N257RARC | The billing provider's NPI is missing, incomplete, or not valid. | Correct the billing NPI to match enrollment and resubmit. |
| N264RARC | The ordering provider's name is missing, incomplete, or not valid. | Add the ordering provider's name exactly as enrolled and resubmit. |
| N265RARC | The ordering provider's NPI is missing, incomplete, or not valid. | Add the ordering provider NPI; confirm they are enrolled in PECOS for Medicare. |
| N286RARC | The referring provider's NPI is missing, incomplete, or not valid. | Add the correct referring provider NPI and resubmit. |
| N290RARC | The rendering provider's NPI is missing, incomplete, or not valid. | Add the rendering NPI and confirm that provider is enrolled with the payer. |
| N293RARC | The service facility's NPI is missing, incomplete, or not valid. | Add the correct service facility NPI and address and resubmit. |
| N329RARC | Patient date of birth is missing, incomplete, or not valid. | Match DOB to the insurance card and resubmit. |
| N347RARC | Payment for this referred or purchased service was already made to another provider. | Coordinate with the other provider who was paid; do not rebill. |
| N350RARC | The description for an unlisted or not otherwise classified code is missing or invalid. | Add a clear narrative description and attach supporting records, then resubmit. |
| N356RARC | Not covered when done with or after a non-covered service. | Review whether the primary service was covered; appeal if it was, or bill patient per ABN. |
| N362RARC | Days or units billed exceed the payer's allowed maximum. | Check MUE and payer unit limits; appeal with records or split lines only if allowed. |
| N381RARC | Informational: see your contract for restrictions, billing, or payment terms for these charges. | Review your contract terms; dispute if payment does not match the agreement. |
| N382RARC | The patient identifier is missing, incomplete, or not valid. | Verify the member ID on the current card, including any prefix, and resubmit. |
| N386RARC | Decision was based on a National Coverage Determination (NCD) policy. | Read the NCD; check covered diagnoses, frequency, and ABN; appeal if criteria were met. |
| N390RARC | This service or report cannot be billed separately. | Write off unless documentation shows a separate service; review bundling rules. |
| N418RARC | Claim was sent to the wrong payer or address. | Check the payer's submission instructions and resubmit to the correct payer ID. |
| N425RARC | Service is excluded from coverage by law. | Bill the patient; for Medicare, use the GY modifier. An ABN is optional for excluded services. CO-96 guide |
| N428RARC | Service is not covered in this place of service. | Verify POS; correct if wrong, or confirm the service is allowed in that setting. |
| N432RARC | Informational: adjustment results from a Recovery Audit (RAC) review. | Review the RAC finding and appeal within the deadline if you disagree. |
| N434RARC | Present on Admission (POA) indicator is missing, incomplete, or not valid. | Add a POA indicator for each diagnosis on the inpatient claim and resubmit. |
| N435RARC | Exceeds the allowed number or frequency in the time period without supporting documentation. | Send records showing medical need for the extra services and request reconsideration. |
| N448RARC | This drug, service, or supply is not on the fee schedule or contract. | Confirm the code is valid; request a rate or bill an appropriate alternative code. |
| N479RARC | Explanation of Benefits from the primary payer or Medicare Secondary Payer is missing. | Attach the primary EOB or send COB/MSP data electronically and resubmit. |
| N480RARC | Explanation of Benefits from the primary or MSP payer is incomplete or not valid. | Send a complete, legible primary EOB that matches the claim lines. |
| N489RARC | The referral form is missing. | Obtain the referral from the PCP and resubmit with the referral number. |
| N517RARC | Submit a new claim with the information that was requested. | Add the requested data and submit a new claim, not a corrected one. |
| N519RARC | The combination of HCPCS modifiers on the line is not valid. | Review modifier order and compatibility, remove conflicting modifiers, and resubmit. |
| N521RARC | Provider information on the claim does not match the payer's records. | Compare NPI, TIN, name, and address to enrollment; update records or correct the claim. |
| N522RARC | This is a duplicate of a claim processed, or to be processed, as a crossover. | Do not bill the secondary payer directly; wait for the crossover to process. |
| N525RARC | Services are not covered during the global period of another procedure. | Check the global period; use modifier 24, 25, 57, 58, 78, or 79 if supported. |
| N544RARC | Informational: paid, but the referring or ordering provider does not match payer records; future claims may deny. | Correct ordering/referring name and NPI to match enrollment on future claims. |
| N550RARC | Informational: you have not answered revalidation requests; payments may be held. | Complete enrollment revalidation, such as in PECOS, right away. |
| N563RARC | Informational: required advance notice of non-coverage was not given; patient is not liable. | Write off the charge; issue ABNs properly going forward. |
| N569RARC | Service is not covered for the diagnosis reported. | Check the policy's covered diagnoses; correct coding if wrong or appeal with records. |
| N570RARC | Credentialing data is missing, incomplete, or not valid. | Finish or update credentialing with the payer, then resubmit. |
| N572RARC | Procedure is not payable unless required reporting codes and modifiers are also billed. | Add the required non-payable reporting codes and modifiers, then resubmit. |
| N574RARC | Ordering or referring provider is a type or specialty not allowed to order or refer. | Verify the ordering provider's specialty and enrollment; use an eligible orderer. |
| N575RARC | Ordering or referring provider name does not match the payer's records. | Use the name exactly as listed in enrollment, such as PECOS, and resubmit. |
| N587RARC | The patient has used up all available benefits under the policy. | Confirm the benefit maximum; bill secondary coverage or the patient. |
| N598RARC | The health care policy is primary for this claim. | Bill the health plan as primary, not the auto or other liability carrier. |
| N620RARC | Informational: this code is for quality reporting only and has no payment. | No action needed; the zero payment is expected. |
| N630RARC | Referral was not authorized by the attending physician. | Get a valid referral from the attending or PCP and resubmit. |
| N640RARC | Exceeds the number or frequency allowed in the time period. | Verify frequency limits; appeal with medical need or bill patient with a valid ABN. |
| N657RARC | Service should be billed with the correct code for what was provided. | Review documentation, choose the appropriate code, and submit a corrected claim. |
| N674RARC | Not covered unless a required prior procedure or service was done first. | Document that the prerequisite service occurred and appeal or resubmit. |
| N702RARC | Decision based on review of past or pending claims for the same or similar services. | Review claim history for overlap; appeal with records if services were distinct. |
| N705RARC | Documentation is incomplete or not valid. | Send complete, signed, dated documentation that supports the service. |
| N706RARC | Required documentation is missing. | Send the requested records with the payer's reference number. |
| N767RARC | State Medicaid requires the provider to enroll in its program before paying claims. | Enroll with the patient's state Medicaid program, then resubmit. |
| N776RARC | Payer does not cover this service when delivered by telehealth. | Check the payer's telehealth code list and POS/modifier rules; correct or bill patient. |
| N779RARC | Replacement or void claims cannot be sent until the original claim finalizes. | Wait for the original claim to finalize, then send the replacement or void. |
| N781RARC | Informational: patient is Medicaid/QMB; refund any deductible wrongly collected; amount may go to next payer. | Refund any deductible collected from the patient; bill Medicaid as secondary. |
| N782RARC | Informational: patient is Medicaid/QMB; refund any coinsurance wrongly collected; amount may go to next payer. | Refund any coinsurance collected from the patient; bill Medicaid as secondary. |
| N783RARC | Informational: patient is Medicaid/QMB; refund any copay wrongly collected; amount may go to next payer. | Refund any copay collected from the patient; bill Medicaid as secondary. |
| N807RARC | Payment adjusted under the Merit-based Incentive Payment System (MIPS). | No claim action; review your MIPS score and feedback reports. |
| N815RARC | The NDC unit count is missing, incomplete, or not valid. | Add the NDC quantity and unit qualifier, such as UN or ML, and resubmit. |
| N822RARC | Required procedure modifier is missing. | Add the required modifier, such as laterality or professional component, and resubmit. |
| N823RARC | A procedure modifier is incomplete or not valid. | Verify the modifier is valid for the code and date, correct it, and resubmit. |
| N831RARC | You have not responded to requests to revalidate your enrollment. | Complete revalidation with the payer or PECOS, then resubmit held claims. |
| N864RARC | Informational: claim falls under No Surprises Act rules for emergency services. | Bill the patient only in-network cost sharing; review payment for open negotiation. |
| N877RARC | Informational: initial out-of-network payment under the No Surprises Act; you may start open negotiation. | If payment is too low, start open negotiation within 30 business days. |
| N891RARC | Primary insurance already paid the maximum allowed amount, so nothing more is due. | Post the zero payment; bill the patient only for remaining PR amounts, if any. |
| N892RARC | Claim does not meet the criteria for using the delay reason code. | Review late filing rules; resubmit with proof of timely filing or a valid delay reason. |
| N921RARC | The deadline to file a reconsideration or appeal has passed. | Check if good cause applies; otherwise write off the balance. |
No match. Check the full official lists from X12 (CARC) and X12/CMS (RARC), or ask us.
About the code descriptionsDescriptions are BetaQuick's plain-English summaries of the code lists published through X12, current as of October 2026. Lists change several times a year, so check the official wording before quoting a code in an appeal. RARCs shown are the most common; the full RARC list has more than 1,100 active codes.
2. What CARC and RARC codes are
- CARC (Claim Adjustment Reason Code): the reason for an adjustment, such as "deductible", "duplicate claim", or "time limit for filing has expired". Every adjustment on a remittance carries one.
- RARC (Remittance Advice Remark Code): supplemental information, such as which field is missing or which policy was applied. RARCs start with M, MA, or N. CMS maintains the RARC list.
Both lists are published through X12 and updated several times a year. Codes are added, revised, and retired, so billing systems need current lists.
3. Group codes: CO, PR, OA, PI
| Group code | Stands for | What it means for billing |
|---|---|---|
| CO | Contractual Obligation | Provider responsibility. Cannot be billed to the patient. |
| PR | Patient Responsibility | Can be billed to the patient or a secondary payer. |
| OA | Other Adjustment | Used when neither CO nor PR applies, for example some coordination of benefits adjustments. |
| PI | Payer Initiated Reduction | A reduction the payer made that is not a contractual obligation and not the patient's responsibility. |
Read the group code first. The same CARC can mean very different things for collections: CO-50 is a provider write-off or appeal, while PR-50 can be billed to the patient.
4. Where they appear on the 835
- CARCs appear in CAS segments, at the claim level (loop 2100) and the service line level (loop 2110), with the group code and amount.
- RARCs appear in LQ segments at the service line level, and in MIA or MOA segments at the claim level.
If your team reads paper or PDF remittances, these show up as columns next to each line. Our 835 payment posting guide goes deeper on the file.
5. How to use CARC and RARC data to cut denials
- Export 90 days of remittance adjustments with group code, CARC, RARC, payer, CPT, and provider.
- Leave out the routine ones (PR-1, PR-2, PR-3, CO-45) and rank the rest by dollars.
- Group by root cause, not by code. CO-16 with N290 and CO-185 might both trace back to provider enrollment.
- Fix the top three causes upstream: scrubber edits, eligibility checks, enrollment, or documentation.
- Re-run the same report monthly and track dollars denied per cause.
For a Medicare-specific view, see our Medicare denial codes reference. For the recovery workflow, see the denial recovery playbook.
Is your team reading every CARC and RARC manually?
We build the software that does the repetitive part of denial work: reading every remittance, sorting denials by cause, and drafting the correction or appeal. Your team approves before anything goes out.
Book a 20-minute look →Frequently asked questions
How many CARC and RARC codes are there?
As of October 2026 there are 297 active CARC codes and more than 1,100 active RARCs. Codes are added, revised, and retired several times a year, so totals change.
What is CARC 227?
CARC 227: Information requested from the patient or insured was missing or incomplete. Ask the patient to respond to the payer, then request reprocessing.
What is CARC 181?
CARC 181: The procedure code was not valid on the date of service. Check the code set for that date; correct the code and resubmit.
What is the difference between a CARC and a RARC?
A CARC explains why a claim or line was adjusted. A RARC adds supporting detail, such as which field was missing or which policy applied. A remittance can include a CARC alone, but many CARCs, like 16, require a RARC.
What do the group codes CO, PR, OA, and PI mean?
CO is contractual obligation (provider responsibility), PR is patient responsibility, OA is other adjustment, and PI is a payer-initiated reduction. The group code tells you who owns the unpaid amount.
Who maintains CARC and RARC codes?
CARCs are maintained by a code maintenance committee and published through X12. RARCs are maintained by CMS and also published through X12. Both are updated several times a year.
Where do I find the official CARC and RARC list?
The current lists are published on the X12 website. CMS also publishes RARC updates. Billing software should load the current lists automatically.
What are the most common denial codes?
Frequent ones include CO-16 (missing information), CO-97 (bundled), CO-50 (medical necessity), CO-197 (no authorization), CO-29 (timely filing), CO-18 (duplicate), and CO-22 (coordination of benefits). Which ones dominate depends on your specialty and payer mix.
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