Denial Codes (CARC)
What each denial code means, the fix, and the appeal path. 47 entries.
CO-4 is a claim adjustment reason code meaning the procedure code is inconsistent with the modifier used, or a required…
CO-6 Denial Code: Procedure/Revenue Code Inconsistent With Patient AgeCO-6 is a claim adjustment reason code meaning the procedure or revenue code is inconsistent with the patient's age. It…
CO-11 Denial Code: Diagnosis Inconsistent With the ProcedureCO-11 means the diagnosis is inconsistent with the procedure — the ICD-10 code on the claim does not logically support …
CO-15 Denial Code: Missing, Invalid, or Inapplicable Authorization NumberCO-15 is a claim adjustment reason code meaning the authorization number is missing, invalid, or does not apply to the …
CO-16 Denial Code: Claim Lacks Information or Has Submission ErrorsCO-16 means the claim or service lacks information or has submission/billing errors. It never travels alone: the accomp…
CO-18 Denial Code: Exact Duplicate Claim or ServiceCO-18 is a claim adjustment reason code meaning the payer received an exact duplicate claim or service: same patient, p…
CO-19 Denial Code: Work-Related Injury, Liability of Workers' Compensation CarrierCO-19 means this is a work-related injury or illness and thus the liability of the Workers' Compensation carrier — the …
CO-22 Denial Code: Care May Be Covered by Another Payer (Coordination of Benefits)CO-22 is a claim adjustment reason code meaning this care may be covered by another payer per coordination of benefits.…
CO-23 Denial Code: Impact of Prior Payer(s) AdjudicationCode 23 means the adjustment reflects the impact of prior payer(s) adjudication, including payments and/or adjustments.…
CO-24 Denial Code: Charges Covered Under a Capitation Agreement or Managed Care PlanCO-24 is a claim adjustment reason code meaning charges are covered under a capitation agreement or managed care plan. …
CO-27 Denial Code: Expenses Incurred After Coverage TerminatedCO-27 is a claim adjustment reason code meaning expenses were incurred after the patient's coverage terminated. The pol…
CO-29 Denial Code: The Time Limit for Filing Has ExpiredCO-29 means the time limit for filing has expired — the claim arrived after the payer's timely filing deadline. Medicar…
CO-31 / PR-31 Denial Code: Patient Cannot Be Identified As Our InsuredCARC 31 means the patient cannot be identified as the payer's insured — the demographic or member ID data submitted did…
CO-45 Denial Code: Charge Exceeds Fee Schedule / Maximum AllowableCO-45 means the charge exceeds the fee schedule, maximum allowable, or contracted/legislated fee arrangement. It is a c…
CO-50 Denial Code: Non-Covered Services Not Deemed Medically NecessaryCO-50 means the payer denied the service as not medically necessary — the diagnosis on the claim does not justify the p…
CO-59 Denial Code: Processed Based on Multiple or Concurrent Procedure RulesCO-59 means the service was processed under multiple or concurrent procedure rules — multiple surgery, diagnostic imagi…
CO-96 Denial Code: Non-Covered Charge(s)CO-96 is a claim adjustment reason code meaning non-covered charge(s): the service is excluded from the patient's benef…
CO-97 Denial Code: Benefit Included in Payment for Another ServiceCO-97 means the benefit for this service is included in the payment or allowance for another service already adjudicate…
CO-107 Denial Code: Related or Qualifying Claim/Service Not IdentifiedCO-107 means the related or qualifying claim or service was not identified on this claim — a billed service depends on …
CO-109 Denial Code: Claim/Service Not Covered by This Payer/ContractorCO-109 is a claim adjustment reason code meaning the claim or service is not covered by this payer or contractor and mu…
CO-119 Denial Code: Benefit Maximum for This Time Period ReachedCO-119 is a claim adjustment reason code meaning the benefit maximum for this time period or occurrence has been reache…
CO-131 Denial Code: Claim Specific Negotiated DiscountCO-131 means a claim specific negotiated discount was applied — the provider and payer agreed to an allowance below bil…
CO-140 / PR-140 Denial Code: Patient/Insured ID Number and Name Do Not MatchCARC 140 means the patient or insured health identification number and name do not match the payer's records — a data-v…
CO-146 Denial Code: Diagnosis Was Invalid for the Date(s) of ServiceCO-146 means the diagnosis was invalid for the date(s) of service reported — the ICD-10 code was expired, not yet effec…
CO-151 Denial Code: Information Does Not Support This Many/Frequency of ServicesCO-151 is a claim adjustment reason code meaning payment was adjusted because the payer deems the submitted information…
CO-167 Denial Code: Diagnosis(es) Not CoveredCO-167 is a claim adjustment reason code meaning this diagnosis or these diagnoses are not covered. The ICD-10 code on …
CO-170 Denial Code: Payment Denied When Performed/Billed by This Type of ProviderCO-170 is a claim adjustment reason code meaning payment is denied when performed or billed by this type of provider. T…
CO-181 Denial Code: Procedure Code Was Invalid on the Date of ServiceCO-181 means the procedure code was invalid on the date of service — the CPT or HCPCS code was expired, not yet effecti…
CO-183 Denial Code: Referring Provider Not Eligible to Refer the Service BilledCO-183 means the referring provider is not eligible to refer the service billed — the referring NPI on the claim is mis…
CO-197 Denial Code: Precertification/Authorization/Notification AbsentCO-197 is a claim adjustment reason code meaning precertification, authorization, notification, or pre-treatment requir…
CO-198 Denial Code: Precertification/Notification/Authorization ExceededCO-198 is a claim adjustment reason code meaning precertification, notification, authorization, or pre-treatment limits…
CO-204 Denial Code: Service Not Covered Under the Patient's Benefit PlanCO-204 means the service, equipment, or drug is not covered under the patient's current benefit plan. With the CO group…
CO-231 Denial Code: Mutually Exclusive Procedures Same Day or SettingCO-231 means mutually exclusive procedures cannot be done in the same day or setting. The payer paid one procedure and …
CO-236 Denial Code: Procedure or Modifier Combination Not Compatible (NCCI)CO-236 means this procedure or procedure/modifier combination is not compatible with another combination billed the sam…
CO-252 Denial Code: Attachment or Other Documentation RequiredCO-252 means an attachment or other documentation is required to adjudicate the claim — it is a records request, not a …
CO-B7 Denial Code: Provider Not Certified or Eligible on This Date of ServiceCO-B7 means this provider was not certified or eligible to be paid for this procedure or service on this date of servic…
CO-B15 Denial Code: Qualifying Service Not Received or AdjudicatedCO-B15 means the billed service requires a qualifying service or procedure to be received and covered first, and that q…
OA-18 Denial Code: Exact Duplicate Claim or ServiceOA-18 means exact duplicate claim/service — the payer already has a claim matching this patient, provider, date, code, …
OA-23 Denial Code: Impact of Prior Payer AdjudicationOA-23 means "the impact of prior payer(s) adjudication including payments and/or adjustments" — used only with Group Co…
PI-204 Denial Code: Service Not Covered Under the Patient's Benefit PlanPI-204 pairs CARC 204 — service, equipment, or drug not covered under the patient's current benefit plan — with the Pay…
PR-1 Denial Code: Deductible AmountPR-1 means Deductible Amount: the payer applied the allowed amount (or part of it) to the patient's unmet annual deduct…
PR-2 Denial Code: Coinsurance AmountPR-2 is a claim adjustment reason code meaning coinsurance amount: the percentage of the allowed amount the patient owe…
PR-3 Denial Code: Co-payment AmountPR-3 is a claim adjustment reason code meaning co-payment amount: the flat per-visit fee the patient owes under their p…
PR-27 Denial Code: Expenses Incurred After Coverage TerminatedPR-27 means expenses were incurred after coverage terminated — the patient's policy had ended before the date of servic…
PR-49 Denial Code: Non-Covered Routine / Preventive Exam or ScreeningPR-49 means the service is non-covered because it is a routine/preventive exam or a screening procedure done in conjunc…
PR-119 Denial Code: Benefit Maximum for This Time Period or Occurrence ReachedPR-119 means the benefit maximum for this time period or occurrence has been reached — the patient has used up a capped…
PR-204 Denial Code: Service Not Covered Under the Patient's Benefit PlanPR-204 means the service, equipment, or drug is not covered under the patient's current benefit plan, and the PR group …
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