CARC 117: Transportation Covered Only to Closest Appropriate Facility

What it means

This denial means the payer determined that the patient was transported (typically via ambulance) to a facility farther away than the nearest one capable of providing the needed level of care. Payers generally only reimburse transportation costs up to the distance to the closest appropriate facility, so any mileage or charges beyond that point may be denied or reduced.

Common causes

Ambulance transported the patient past a closer facility with equivalent capabilities to a preferred or requested hospital
Documentation does not clearly justify why a farther facility was medically necessary (e.g., specialized trauma, burn, or stroke center)
Patient or family requested a specific hospital that was not the nearest appropriate one
Missing or incomplete documentation of facility capability at the closer location
Coding/billing reflects total mileage rather than mileage to the nearest appropriate facility

How to fix it

Review the patient care report (PCR) and dispatch records to confirm the distance to the nearest appropriate facility versus the facility actually used
Gather documentation showing medical necessity for bypassing closer facilities (e.g., lack of specialized services, diversion status, or physician orders)
If bypass was justified, submit an appeal with supporting clinical documentation (e.g., trauma level, stroke/STEMI protocols, capacity issues at closer facility)
If the longer distance was not medically justified, adjust the claim to bill only for mileage to the nearest appropriate facility
Verify local EMS protocols and payer-specific transportation policies to ensure compliance before resubmitting

Appeal / resubmit

When appealing, include documentation that clearly demonstrates the nearest facility could not provide the required level of care—such as lack of specialty equipment, active diversion status, or a physician's order specifying transport to a higher-level facility. Highlight any protocol-driven decisions (e.g., trauma, stroke, or cardiac alert criteria) that mandated transport to a more distant, appropriately equipped facility. This documentation review does not guarantee the appeal will be successful, but it strengthens the case for medical necessity.

Related codes

Frequently asked

Does this mean the ambulance ride itself won't be paid at all?

Not necessarily. Payers may still reimburse for transportation, but only up to the mileage and cost associated with the nearest facility capable of providing the needed care. Charges beyond that distance may be denied.

What if the closest hospital didn't have the right specialists?

If documentation shows the nearest facility lacked the necessary capability (e.g., no trauma center, no cath lab), this can support medical necessity for bypassing it and may be used in an appeal.

Can patient preference justify going to a farther hospital?

Generally, patient or family preference alone is not sufficient justification under most payer policies; medical necessity must be clearly documented.

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

This content is informational only and does not constitute billing or legal advice. It does not guarantee claim outcomes or reimbursement.