CARC 198 appeal letter template — Precertification/Authorization Exceeded

CARC 198 indicates the claim exceeded the scope, units, visits, or timeframe approved under the existing precertification/authorization. This template helps draft an appeal when the billed services were medically appropriate and documentation supports that the authorization limits were misapplied or additional services were clinically warranted.

When to appeal vs. correct & resubmit

Appeal when you believe the authorization was miscounted, the payer's system applied the wrong authorization number, the authorized units/visits were insufficient given documented medical need, or additional services were a continuation of care that should have been covered under an extension/retro-authorization. If the authorization genuinely lapsed or was never requested for the extra units due to a billing oversight, first check whether a retroactive or corrected authorization can be obtained, or correct and resubmit with the proper authorization number rather than appealing.

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]
Attn: Appeals Department
[Payer Address]

Re: Appeal of Claim Denial — CARC 198 (Precertification/Authorization Exceeded)
Patient Name: [Patient Name]
Member ID: [Member ID]
Claim #: [Claim #]
Date(s) of Service: [DOS]
Provider: [Provider Name, NPI]
CPT/HCPCS: [CPT/HCPCS]
Authorization #: [Authorization #]

Dear Appeals Reviewer,

This letter serves as a formal appeal of the above-referenced claim, which was denied under CARC 198, described as "Precertification/authorization exceeded." We respectfully request reconsideration of this denial for the following reasons:

1. [Explain why the services billed should be considered within the scope of the existing authorization, e.g., continuation of an approved treatment plan, additional medically necessary units/visits, or authorization span that should cover the date(s) of service.]
2. [Note any discrepancy between the authorization on file (Authorization #) and what the payer's system applied to this claim, if applicable.]
3. [Summarize clinical justification for why the number of units/visits/services exceeded the original authorization, if relevant, and reference supporting documentation.]

Enclosed please find supporting documentation, including the original authorization confirmation, relevant medical records, and the Explanation of Benefits/Electronic Remittance Advice (EOB/ERA) reflecting the CARC 198 denial. We ask that you review this information and reconsider coverage for the services rendered on [DOS].

Please contact our office at [Phone] or [Email] if additional information is needed to complete this review. We appreciate your prompt attention to this appeal.

Sincerely,

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

What to attach

• Original authorization approval letter or confirmation number
• EOB/ERA showing the CARC 198 denial
• Relevant medical records supporting medical necessity of services beyond initial authorization
• Treatment plan or progress notes documenting continuation of care
• Authorization request/extension documentation, if submitted
• Itemized billing statement for the disputed claim

Frequently asked questions

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

This template is for informational and administrative purposes only and does not constitute legal, billing, or coding advice. It is not a guarantee of appeal success or claim payment. Always verify requirements with the specific payer and consult qualified billing or legal professionals as needed.