Common Claim Adjustment & Denial Reason Codes (CARC & RARC)
In medical billing, Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) explain why a claim was denied, adjusted, or paid differently than expected.
Understanding these codes is essential for Accounts Receivable (AR) and RCM teams — it helps them quickly spot the root cause of denials, take the right corrective action, and prevent the same issues from happening again.
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| Code | Description |
|---|---|
| 1 | Deductible Amount |
| 4 | The procedure code inconsistent with the modifier used or a required modifier is missing |
| 5 | The procedure code/type of bill is inconsistent with the place of service |
| 6 | The procedure/revenue code is inconsistent with the patient’s age |
| 7 | The procedure/revenue code is inconsistent with the patient’s gender |
| 8 | The procedure code is inconsistent with the provider type/specialty (taxonomy) |
| 9 | The diagnosis is inconsistent with the patient’s age |
| 10 | The diagnosis is inconsistent with the patient’s gender |
| 11 | The diagnosis is inconsistent with the procedure |
| 13 | The date of death precedes the date of service |
| 16 | Claim/service lacks information or has submission/billing error(s) |
| 18 | Exact duplicate claim/service |
| 19 | This is a work-related injury/illness and thus the liability of the Worker’s Compensation Carrier |
| 20 | This injury/illness is covered by the liability carrier |
| 21 | This injury/illness is the liability of the no-fault carrier |
| 22 | This care may be covered by another payer per coordination of benefits |
| 23 | The impact of prior payer(s) adjudication including payments and/or adjustment |
| 24 | Charges are covered under a capitation agreement/managed care plan |
| 26 | Expenses incurred prior to coverage |
| 27 | Expenses incurred after coverage terminated |
| 29 | The time limit for filing has expired |
| 31 | Patient cannot be identified as our insured |
| 45 | Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement |
| 49 | This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam |
| 50 | These are non-covered services because this is not deemed a ‘medical necessity’ by the payer |
| 51 | These are non-covered services because this is a pre-existing condition |
| 55 | Procedure/treatment/drug is deemed experimental/investigational by the payer |
| 58 | Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service |
| 96 | Non-Covered Charges |
| 97 | The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated |
| 100 | Payment made to Patient/Insured/Responsible party |
| 109 | Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor |
| 119 | Benefit Maximum for this time period or occurrence has been reached |
| 129 | Prior processing information appears incorrect |
| 140 | Patient/Insured health identification number and name do not match |
| 146 | Diagnosis was invalid for the date(s) of service reported |
| 150 | Payer deems the information submitted does not support this level of service |
| 151 | Payment adjusted because the payer deems the information submitted does not support this many/frequency of services |
| 163 | Attachment/other documentation referenced on the claim was not received |
| 181 | Procedure code was invalid on the date of service |
| 182 | Procedure modifier was invalid on the date of service |
| 183 | The referring provider is not eligible to refer the service billed |
| 185 | The rendering provider is not eligible to perform the service billed |
| 197 | Precertification/Authorization/Notification/Pre-treatment absent |
| 199 | Revenue code and Procedure code do not match |
| 226 | Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete |
| 227 | Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete |
| 234 | This procedure is not paid separately |
| 236 | This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/fee schedule requirements |
| 242 | Services not provided by network/primary care providers |
| 288 | Referral absent |
| MA04 | Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible |
| B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service |
| B9 | Patient is enrolled in a Hospice |
| B20 | Procedure/service was partially or fully furnished by another provider |
| M119 | Missing/incomplete/invalid/deactivated/withdrawn National Drug Code (NDC) |
| MA120 | Missing/incomplete/invalid CLIA certification number |