CARC 234 appeal letter template — Procedure Not Paid Separately (Bundled Service)

CARC 234 means the payer determined the billed procedure is bundled into or incidental to another service/payment and is not separately reimbursable. This template helps staff challenge the bundling determination when separate payment is supported by documentation, coding guidelines, or applicable modifiers.

When to appeal vs. correct & resubmit

Appeal when you believe the procedure was distinct, separately identifiable, and supported by documentation (e.g., different session, different anatomic site, unrelated to the other billed service), or when an appropriate modifier (e.g., 59/XE/XS/XU) was omitted or not properly recognized. Correct and resubmit instead if the service was in fact integral to the primary procedure, if a required modifier was missing in error and can simply be added via corrected claim, or if the payer's bundling edit is accurate per standard coding rules.

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 234 (Procedure Not Paid Separately)
Patient Name: [Patient Name]
Member ID: [Member ID]
Claim #: [Claim #]
Date(s) of Service: [DOS]
Provider: [Provider Name, NPI]
CPT/HCPCS Code(s) in Dispute: [CPT/HCPCS]

Dear Appeals Reviewer,

This letter is a formal appeal of the above claim, which was denied under CARC 234, indicating 'This procedure is not paid separately.' We respectfully request reconsideration and separate reimbursement for the identified procedure code(s).

Based on our review of the medical record, the service billed as [CPT/HCPCS] was a distinct, separately identifiable procedure performed on [DOS], and was not incidental to or inherently included in the other service(s) billed on this claim. [Insert specific clinical rationale: e.g., different anatomic site, separate session, unrelated diagnosis, or medical necessity for performing both services independently.]

Enclosed please find supporting documentation, including the operative/procedure note, relevant chart excerpts, and coding references, which demonstrate that the procedure meets criteria for separate payment under standard CPT/HCPCS unbundling conventions. [If applicable: An appropriate modifier, such as [Modifier], has been appended to reflect the distinct nature of this service and was correctly submitted/is being resubmitted with this appeal.]

We ask that the claim be reprocessed to allow separate payment for CPT/HCPCS [CPT/HCPCS] in accordance with the enclosed documentation. If additional information is needed, please contact our office at [Phone] or [Email].

Thank you for your attention to this matter.

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

What to attach

• Explanation of Benefits (EOB) / Electronic Remittance Advice (ERA) showing CARC 234
• Operative report or procedure note documenting the service(s) performed
• Relevant chart notes supporting distinct/separate nature of the procedure
• Coding reference or payer bundling policy excerpt (if available)
• Corrected claim form with appropriate modifier, if applicable
• Cover letter summarizing the clinical and coding rationale for separate payment

Frequently asked questions

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

This template is for informational purposes only and does not constitute legal, billing, or coding advice. It does not guarantee any specific outcome, including claim approval or overturned denial. Review payer-specific policies and consult a qualified billing or legal professional as needed before submission.