CARC 112: Service Not Furnished Directly to the Patient and/or Not Documented

What it means

The payer denied or reduced payment because the documentation submitted doesn't show that the billed service was actually delivered directly to the patient, or the supporting documentation is missing entirely. This is often a documentation-completeness issue rather than a coverage issue.

Common causes

Missing or incomplete clinical documentation supporting the service billed
Documentation does not clearly show the service was rendered directly to the patient (e.g., billed as if performed in person but records suggest otherwise)
Service was performed by someone other than the billing provider without proper supervision documentation
Incident-to or telehealth requirements not met or not documented
Documentation submitted does not match the date of service or CPT/HCPCS code billed
Records were not attached or were sent to the wrong payer department

How to fix it

Pull the medical record for the date of service and confirm it clearly documents the service billed, including who performed it and where
Verify the service meets payer-specific requirements for direct patient contact (e.g., incident-to, telehealth, or supervision rules)
If documentation exists but wasn't submitted, resubmit the claim with complete supporting records (progress notes, orders, encounter forms)
If documentation is incomplete, work with the treating provider to complete or amend notes per proper documentation practices before resubmitting
Check payer-specific policies for the code billed to confirm direct-service or supervision requirements
Submit a corrected claim or appeal with the additional documentation attached

Appeal / resubmit

When appealing, attach the complete encounter documentation showing date, time, location, and the practitioner who directly furnished the service. If the service was provided under supervision (e.g., incident-to), include documentation of the supervising provider's involvement per payer rules. Reference the specific payer policy or manual section defining 'direct' service requirements if available, and clearly map the documentation to the billed CPT/HCPCS code and date of service.

Related codes

Frequently asked

Does this code mean the claim was denied for medical necessity?

No. It typically means the documentation doesn't demonstrate the service was directly furnished to the patient or is missing, not that the service wasn't medically necessary.

What's the fastest way to resolve this denial?

Review the clinical note for that date of service, confirm it supports the billed service and direct patient contact, and resubmit with the documentation attached if it was previously missing.

Could this relate to incident-to billing rules?

Yes. If a non-physician practitioner performed the service, the payer may need documentation confirming proper supervision and direct involvement requirements were met.

More free billing tools: all denial codes · denial lookup · Medicare fee calculator

This content is informational only and is not billing or legal advice. Verify requirements with the specific payer and consult qualified billing/compliance staff before taking action.