CARC 150: Payer Deems Information Submitted Does Not Support This Level of Service

What it means

The payer reviewed the documentation submitted with the claim and determined it does not justify billing at the level of service, complexity, or intensity that was coded. This often happens with evaluation and management codes, or procedures where documentation must clearly support medical necessity for a higher-level code.

Common causes

Documentation does not support the complexity or time associated with the billed E/M level
Missing or insufficient clinical notes justifying medical necessity for the service level billed
Coding does not align with payer-specific medical policy or level-of-service guidelines
Key documentation elements (history, exam, medical decision-making, or time) were incomplete
Claim was submitted with a higher-level code than what the clinical record substantiates

How to fix it

Pull the medical record and compare it against the payer's documentation requirements for the billed code
Determine if the documentation actually supports a lower-level code and consider whether a corrected claim is appropriate
If documentation does support the original level, gather and organize the specific notes, test results, or time logs that justify it
Submit a reconsideration or appeal with the supporting documentation clearly highlighted
Review payer-specific level-of-service guidelines (e.g., E/M documentation guidelines) to prevent recurrence
Educate providers on documentation practices that clearly support the level of service billed

Appeal / resubmit

When appealing, include the complete relevant documentation (history, exam findings, medical decision-making, time spent, or complexity indicators) that supports the level billed, and reference the specific payer policy or coding guideline that applies. A cover letter summarizing how the documentation meets the criteria for the billed level can help reviewers quickly identify support. If documentation genuinely falls short, resubmitting with a corrected, lower-level code may resolve the issue faster than appealing.

Related codes

45
97
16
N115
M76

Frequently asked

Does CARC 150 mean my claim was denied entirely?

It depends on the payer's process. Some payers deny the full claim, while others down-code the service to a level they believe is supported by the documentation, resulting in a partial payment rather than a full denial.

What documentation typically resolves a CARC 150 denial?

Clear notes addressing history, exam, medical decision-making, or total time spent (depending on the code type), along with any test results or clinical reasoning that support the complexity billed.

Should I automatically resubmit at a lower level?

Not automatically. First review the documentation carefully; if it truly supports the original level, pursue an appeal. If it does not, correcting the code may be the more efficient path.

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This content is informational only and does not constitute billing or legal advice. It does not guarantee any specific outcome or reimbursement.