CARC 96 appeal letter template — Non-Covered Charge(s)
CARC 96 indicates the payer deemed the billed charge(s) non-covered under the patient's plan, with an accompanying remark code required to explain the specific reason; this template helps request clarification and/or appeal when coverage is believed to apply.
When to appeal vs. correct & resubmit
Appeal when you believe the service is covered under the member's plan, the remark code cited appears incorrect or incomplete, or supporting documentation (benefit summary, medical necessity, prior approval) was not considered. If the remark code reveals a simple billing error (e.g., wrong code, missing modifier, bundling issue), correct and resubmit the claim instead of appealing. If no remark code was provided at all, request clarification from the payer before building a full appeal.
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 96 (Non-Covered Charge(s))
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 appeals the denial of the above-referenced claim, which was denied under CARC 96 ("Non-covered charge(s). At least one remark code must be provided."). We respectfully request reconsideration for the following reason(s):
[State basis for appeal — e.g., the service is a covered benefit under the member's plan documents, the remark code cited does not accurately reflect the circumstances of this claim, prior authorization was obtained (see Authorization # above), or supporting clinical documentation establishes medical necessity.]
Per CARC guidance, a remark code is required to specify the reason this charge was treated as non-covered. [If no remark code, or an unclear remark code, was provided: We request that the payer identify the specific remark code and underlying coverage provision relied upon so that we may respond directly to the stated basis for denial.]
Enclosed please find supporting documentation, including the original claim, remittance advice/EOB showing the CARC 96 denial and associated remark code, and [additional supporting records] substantiating that this charge should be covered or payable under the member's benefit plan.
We ask that the payer review the enclosed documentation and the applicable plan benefit terms and reprocess this claim for payment, or provide a detailed written explanation if the denial is upheld.
Please contact us with any questions or if additional information is needed.
Sincerely,
[Provider Name, NPI]
[Practice Name]
[Phone]
[Email] What to attach
- Original claim form (CMS-1500/UB-04)
- Remittance advice/EOB showing CARC 96 and the associated remark code
- Copy of member's benefit plan/coverage summary relevant to the billed service
- Proof of prior authorization, if applicable
- Relevant medical records or physician documentation supporting coverage/medical necessity
- Any prior correspondence with the payer regarding this claim
Frequently asked questions
What does CARC 96 mean?
It means the payer determined the billed charge is not covered, and the remittance should include a remark code explaining the specific reason (e.g., benefit exclusion, plan limitation, or other coverage issue).
What should I check before appealing a CARC 96 denial?
Review the accompanying remark code to understand the exact reason. If it points to a correctable billing error, resubmit with corrections. If you believe the service is covered, gather plan documents and clinical support before appealing.
What if no remark code was listed with CARC 96?
Contact the payer or review the full remittance detail to identify the remark code, since CARC 96 requires one. You may need to request clarification before submitting a full appeal.
Is approval of this appeal guaranteed?
No. Outcomes depend on plan terms, documentation, and payer review; this template does not guarantee reversal of the denial.
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 is a general starting point to be customized by qualified staff based on the specific payer, plan, and claim details. Use of this template does not guarantee that an appeal will be successful or that a denial will be overturned.
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