Denial Codes Reference — CARC & RARC
Plain-English, reviewer-authored reference for every ANSI X12 835 denial code. Claim Adjustment Reason Codes (CARC) tell you why the payer reduced or denied payment. Remittance Advice Remark Codes (RARC) are the informational remarks that accompany them — pair codes, policy pointers, and disambiguation. Every page links the pair so you can work a denial from either side.
Reviewed by QuickIntell Editorial Team · Last reviewed
UpdatedTL;DR
CARC and RARC are the two X12 code sets published on every 835 electronic remittance. CARC explains the financial adjustment (why the payer paid less than billed — bundling, medical necessity, deductible, timely filing, etc.); RARC provides the informational remark that narrows the reason (paired CARC, missing modifier, LCD/NCD citation, coordination of benefits). A denial almost always carries one CARC plus one or more RARCs. Work both: the CARC tells you which remediation path to take, and the RARC tells you which piece of data or documentation is missing.
Most-searched CARC codes
See all 306 CARCs →Ranked by US monthly search demand. Click a code to see plain-English meaning, root causes, prevention checklist, and appeal strategy.
- CARC 16rank #1
Claim/service lacks information or has submission/billing error(s).
- CARC 45rank #2
Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
- CARC 96rank #3
Non-covered charge(s).
- CARC 97rank #4
The benefit for this service is included in the payment/allowance for another service/procedure that has already been a…
- CARC 22rank #5
This care may be covered by another payer per coordination of benefits.
- CARC 50rank #6
These are non-covered services because this is not deemed a 'medical necessity' by the payer.
- CARC 204rank #7
This service/equipment/drug is not covered under the patient's current benefit plan.
- CARC B15rank #8
This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other servi…
- CARC 252rank #9
An attachment/other documentation is required to adjudicate this claim/service.
- CARC B13rank #10
Previously paid. Payment for this claim/service may have been provided in a previous payment.
- CARC 197rank #11
Precertification/authorization/notification/pre-treatment absent.
- CARC B7rank #12
This provider was not certified/eligible to be paid for this procedure/service on this date of service.
Common RARC remark codes
See all 200 RARCs →- RARC M15
Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate pa…
- RARC M25
The information furnished does not substantiate the need for this level of service.
- RARC M62
Missing/incomplete/invalid treatment authorization code.
- RARC M80
Not covered when performed during the same session/date as a previously processed service for the patient.
- RARC N4
Missing/Incomplete/Invalid prior insurance carrier EOB.
- RARC N20
Service not payable with other service rendered on the same date.
- RARC N115
This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining wheth…
- RARC N130
Consult plan benefit documents/guidelines for information about restrictions for this service.
- RARC N362
The number of Days or Units of Service exceeds our acceptable maximum.
- RARC N386
This decision was based on a National Coverage Determination (NCD).
How to use this reference
- Start from the CARC on the remit. The CARC is the financial reason; the RARC is the elaboration. Fix the CARC and the RARC usually resolves.
- Check the paired RARC. Many CARCs have a canonical RARC partner (e.g., CARC 97 + RARC M15 for bundling, CARC 197 + RARC M62 for prior auth). The pair tells you what documentation the payer wants.
- Work the remediation path first. Most denials (modifier, diagnosis specificity, timely filing, patient demographics) clear with a corrected claim, not an appeal.
- Appeal only when the merits warrant it. Each code page includes the appeal letter template language reviewers consider effective against the X12 definition and the typical payer policy.
Stop working the same denials twice
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