Denial Code Decoder

111 codes and growing. Billing on the fee side too? See the Medicare fee reference and the fee calculator.

CARC — Claim Adjustment Reason Codes

• CARC 1 — CARC 1 – Deductible Amount
• CARC 2 — Coinsurance Amount
• CARC 3 — CARC 3 - Co-payment Amount
• CARC 4 — Procedure Code Inconsistent With Modifier or Missing Modifier
• CARC 5 — Procedure Code/Type of Bill Inconsistent with Place of Service
• CARC 6 — Procedure/Revenue Code Inconsistent with Patient's Age
• CARC 7 — Procedure/Revenue Code Inconsistent with Patient's Gender
• CARC 9 — The Diagnosis Is Inconsistent With the Patient's Age
• CARC 10 — Diagnosis Inconsistent with Patient's Gender
• CARC 11 — The Diagnosis Is Inconsistent With the Procedure
• CARC 12 — Diagnosis Inconsistent with Provider Type
• CARC 13 — Date of Death Precedes Date of Service
• CARC 14 — Date of Birth Follows Date of Service
• CARC 15 — Missing, Invalid, or Non-Applicable Authorization Number
• CARC 16 — Claim/Service Lacks Information or Has a Submission/Billing Error
• CARC 19 — Claim Denied – Work-Related Injury/Illness (Workers' Compensation Liability)
• CARC 20 — Injury/Illness Covered by Liability Carrier
• CARC 21 — No-Fault Carrier Liability
• CARC 22 — This Care May Be Covered by Another Payer per Coordination of Benefits
• CARC 23 — Impact of Prior Payer(s) Adjudication
• CARC 24 — Charges Covered Under Capitation Agreement/Managed Care Plan
• CARC 27 — Expenses Incurred After Coverage Terminated
• CARC 29 — The Time Limit for Filing Has Expired
• CARC 31 — Patient Cannot Be Identified as Our Insured
• CARC 33 — Insured Has No Dependent Coverage
• CARC 34 — Insured Has No Coverage for Newborns
• CARC 35 — Lifetime Benefit Maximum Reached
• CARC 38 — Services Not Provided or Authorized by Designated Providers
• CARC 39 — Services Denied at the Time Authorization/Pre-Certification Was Requested
• CARC 40 — Charges Do Not Meet Qualifications for Emergent/Urgent Care
• CARC 44 — CARC 44 - Prompt-Pay Discount
• CARC 45 — Charge Exceeds Fee Schedule/Maximum Allowable Amount
• CARC 49 — Non-Covered Routine/Preventive Exam or Related Screening Procedure
• CARC 50 — Not Deemed a Medical Necessity
• CARC 55 — Procedure/Treatment Deemed Experimental or Investigational
• CARC 58 — Treatment Rendered in an Inappropriate Place of Service
• CARC 66 — Blood Deductible
• CARC 74 — Indirect Medical Education (IME) Adjustment
• CARC 95 — Plan Procedures Not Followed
• CARC 96 — Non-Covered Charge(s)
• CARC 97 — Payment Included in Another Service (Bundled)
• CARC 100 — Payment Made to Patient/Insured/Responsible Party
• CARC 101 — Predetermination: Anticipated Payment Upon Completion of Services or Claim Adjudication
• CARC 102 — CARC 102 – Major Medical Adjustment
• CARC 103 — Provider Promotional Discount
• CARC 104 — Managed Care Withholding
• CARC 107 — Related or Qualifying Claim/Service Not Identified
• CARC 108 — Rent/Purchase Guidelines Were Not Met
• CARC 109 — Claim/Service Not Covered by This Payer/Contractor
• CARC 110 — Billing Date Predates Service Date
• CARC 111 — Not Covered Unless the Provider Accepts Assignment
• CARC 112 — Service Not Furnished Directly to the Patient and/or Not Documented
• CARC 114 — Procedure/Product Not FDA Approved
• CARC 115 — Procedure Postponed, Canceled, or Delayed
• CARC 117 — Transportation Covered Only to Closest Appropriate Facility
• CARC 118 — ESRD Network Support Adjustment
• CARC 119 — Benefit Maximum for Time Period or Occurrence Reached
• CARC 121 — Indemnification Adjustment for Outstanding Member Responsibility
• CARC 125 — Submission/Billing Error(s)
• CARC 128 — Newborn's Services Covered in Mother's Allowance
• CARC 129 — Prior Processing Information Appears Incorrect
• CARC 130 — Claim Submission Fee
• CARC 131 — CARC 131 - Claim Specific Negotiated Discount
• CARC 133 — Claim/Service Pending Further Review
• CARC 136 — Failure to Follow Prior Payer's Coverage Rules
• CARC 140 — Patient/Insured Health ID Number and Name Do Not Match
• CARC 142 — Monthly Medicaid Patient Liability Amount
• CARC 146 — Diagnosis Invalid for Date(s) of Service
• CARC 147 — Provider Contracted/Negotiated Rate Expired or Not on File
• CARC 149 — Lifetime Benefit Maximum Reached
• CARC 150 — Payer Deems Information Submitted Does Not Support This Level of Service
• CARC 151 — CARC 151 - Payer Deems Information Submitted Does Not Support This Many/Frequency of Services
• CARC 152 — Length of Service Not Supported by Documentation
• CARC 165 — Referral Absent
• CARC 166 — Services Submitted After Payer's Referral Submission Requirements
• CARC 167 — This (these) diagnosis(es) is (are) not covered
• CARC 170 — Payment Denied - Provider Type Not Eligible for This Service
• CARC 181 — Procedure Code Invalid on Date of Service
• CARC 182 — Procedure Modifier Invalid on Date of Service
• CARC 183 — The Referring Provider Is Not Eligible to Refer
• CARC 185 — The Rendering Provider Is Not Eligible to Perform the Service
• CARC 187 — Consumer Spending Account Payment (FSA/HSA/HRA)
• CARC 188 — Denial Code 188: Product/Procedure Only Covered When Used Per FDA Recommendations
• CARC 189 — Specific Procedure Code Exists for Unlisted Code Billed
• CARC 192 — Non-Standard Adjustment Code From Paper Remittance
• CARC 197 — Precertification/Authorization/Notification Absent
• CARC 198 — Precertification/Authorization Exceeded
• CARC 199 — Revenue Code and Procedure Code Mismatch
• CARC 200 — Expenses Incurred During Lapse in Coverage
• CARC 201 — Patient Responsible via Workers' Compensation Medicare Set-Aside (WCMSA) Arrangement
• CARC 204 — Service, Equipment, or Drug Not Covered Under Patient's Benefit Plan
• CARC 222 — Exceeds Contracted Maximum Hours/Days/Units for This Provider
• CARC 223 — CARC 223 – Mandated Federal, State, or Local Law/Regulation Adjustment
• CARC 225 — Penalty or Interest Payment by Payer
• CARC 231 — Mutually Exclusive Procedures
• CARC 234 — This Procedure Is Not Paid Separately
• CARC 236 — Procedure or Procedure/Modifier Combination Incompatible with Another Procedure/Modifier
• CARC 246 — CARC 246 – This non-payable code is for required reporting only
• CARC 252 — Additional Documentation Required to Adjudicate Claim
• CARC 253 — Sequestration - Reduction in Federal Payment
• CARC 256 — Service Not Payable Per Managed Care Contract
• CARC 272 — Coverage/Program Guidelines Were Not Met
• CARC 273 — Coverage/Program Guidelines Exceeded
• CARC 288 — Referral Absent (CARC 288)
• CARC 289 — Services Considered Under Dental and Medical Plans – Benefits Not Available

RARC — Remittance Advice Remark Codes

• RARC M25 — M25 - Documentation Does Not Support Level of Service Billed
• RARC M51 — M51: Missing/Incomplete/Invalid Procedure Code(s)
• RARC M119 — M119 - Missing/Incomplete/Invalid National Drug Code (NDC)
• RARC MA63 — MA63 - Missing/Incomplete/Invalid Principal Diagnosis
• RARC N180 — N180 - Item or Service Does Not Meet Billing Category Criteria
• RARC N657 — N657 - Service Should Be Billed With the Appropriate Code