CARC 150 appeal letter template — Information Submitted Does Not Support Level of Service

CARC 150 means the payer determined that the documentation submitted with the claim does not support the level of service billed. This template helps providers submit additional clinical documentation to contest that determination.

When to appeal vs. correct & resubmit

Appeal when the medical record documentation actually supports the level of service billed but was not fully conveyed, was omitted, or was misread by the payer (e.g., history, exam, and medical decision-making elements, time-based documentation, or severity/complexity indicators were present but not clearly captured in the original submission). Correct and resubmit instead if, upon internal review, the documentation genuinely does not support the billed level and a lower level of service or different code is more accurate.

Appeal letter template

Copy the template, replace every [bracketed] field with your details, and keep only the paragraph that fits your situation.

[Date]

[Payer Name]
Appeals Department
[Payer Address]

Re: Appeal of Denial — CARC 150 (Information Submitted Does Not Support Level of Service)
Patient Name: [Patient Name]
Member ID: [Member ID]
Claim #: [Claim #]
Date(s) of Service: [DOS]
Rendering Provider: [Provider Name, NPI]
CPT/HCPCS Code(s) in Dispute: [CPT/HCPCS]

Dear Appeals Review Team,

This letter serves as a formal appeal of the above-referenced claim, which was denied under CARC 150, indicating that the information submitted does not support the level of service billed.

We have reviewed the medical record for the date(s) of service listed above and believe the documentation supports the level of service reported. Enclosed please find the relevant clinical documentation, including [describe specific documentation, e.g., history, examination findings, medical decision-making complexity, time spent, or other supporting detail], which substantiates the code(s) billed.

We respectfully request that the payer reconsider this claim in light of the enclosed documentation. If any additional clarification or supporting material would assist in this review, please contact our office at [Phone] or [Email], and we will promptly provide it.

We appreciate your attention to this matter and look forward to a reconsideration of this claim.

Sincerely,

[Provider Name, NPI]
[Practice Name]
[Phone]
[Email]

Enclosures: [List attachments]

What to attach

• Copy of the original EOB/ERA showing the CARC 150 denial
• Complete medical record/clinical documentation for the date(s) of service billed
• Office/encounter notes supporting history, exam, and medical decision-making or time documentation
• Any relevant test results, imaging reports, or diagnostic findings referenced in the record
• Copy of the original claim form (CMS-1500 or UB-04) as submitted

Frequently asked questions

More free billing tools: all appeal letters · denial codes · NCCI edits · Medicare fees

This template is provided for general informational and administrative purposes only and does not constitute legal, medical, or billing advice. It is a generic fill-in-the-blank framework intended to be customized with accurate, patient-specific information by qualified staff. Submission of an appeal using this template does not guarantee reconsideration, approval, or any particular outcome from the payer.