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CARC 112 · CO-112

CARC 112 Denial: Service not furnished directly to the patient and/or not documented — How to Fix and Appeal

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

TL;DR

CARC 112 (X12 Service not furnished directly to the patient and/or not documented). CARC 112 denies the service because the record does not show the service was delivered directly to the patient or the documentation is missing.

Official X12 description

“Service not furnished directly to the patient and/or not documented.”

Source: X12 Claim Adjustment Reason Codes. The X12 External Code Lists are the single authoritative source for every CARC descriptor — always verify against the current release before building a claim-scrub rule.

What CARC 112 actually means

CARC 112 denies the service because the record does not show the service was delivered directly to the patient or the documentation is missing. Typical scenarios include incident-to billing without the attending on site or telemedicine where the modality/location was not documented. Appeal with the attestation, time stamps, or visit documentation that proves direct patient contact.

Common root causes

  • Service billed without documentation of direct patient contact.
  • Incident-to supervision criteria not met or not documented.
  • Telehealth modality not documented with place of service, time, and patient location.

Prevention checklist

  • Documentation templates that capture modality, location, start/stop time for all services.
  • Incident-to workflow that enforces attending-presence attestation before billing.

Appeal strategy — step by step

Most CARC 112 denials clear faster with the right remediation than with a formal appeal. Work the steps in order and escalate only when a lower-effort path has been ruled out.

  1. 1Appeal with the clinical note showing direct patient contact, time stamps, and attending supervision where required.
Sample appeal-letter language for CARC 112
[Provider letterhead] Re: Appeal of CARC 112 — Claim #{claim_number} Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} On {remittance_date} this claim was adjusted with CARC 112: "Service not furnished directly to the patient and/or not documented." We respectfully request reconsideration. The X12 External Code List definition of CARC 112 does not apply to this claim for the following reasons: 1. [Cite the clinical / coding / policy fact that rebuts the adjustment] 2. [Cite the supporting documentation attached — op note, EOB, LCD/NCD citation, NCCI edit indicator, modifier rationale] 3. [Cite the payer's own policy where applicable] Attached: {list supporting documents} Please process payment under the member's benefits. If additional information is required, contact the billing office at {provider_phone} or {provider_email}. Sincerely, {billing_manager_name}, {credentials}

Edit the bracketed fields before sending. This template is a starting point; a payer-specific appeal form may still be required — check the provider portal first.

Payer-specific notes

Payer-specific behavior for CARC 112 publishes here as the QuickIntell anonymized denial ETL ingests sufficient volume. In the meantime, consult the payer directory for the relevant provider manual and appeal form.

How common is CARC 112?

Search demand rank
#171

Out of 306 seeded CARCs, ranked by combined US monthly search volume for "CARC 112", "CO-112 denial", and "denial code 112".

Platform frequency
Pending ETL

Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).

How QuickRCM prevents CARC 112

QuickRCM catches the root causes above before the 837 leaves the clearinghouse:

  • Claim-scrub rules fire on every root cause listed above — the scrub references the same X12 CAS segment logic that drives the denial, so what the payer checks, QuickRCM checks first.
  • When a denial lands, QuickRCM routes it to the correct worker with the documentation bundle already attached (op note, LCD citation, modifier rationale, EOB, primary 835).
  • Appeal templates tuned to each CARC (including this one) pull the supporting facts from the claim and fill the bracketed fields automatically.
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Frequently asked questions — CARC 112

What does CARC 112 mean?

CARC 112 is an X12 Claim Adjustment Reason Code. The official definition is: "Service not furnished directly to the patient and/or not documented." In plain English, the payer is telling you cARC 112 denies the service because the record does not show the service was delivered directly to the patient or the documentation is missing. Typical scenarios include incident-to billing without the attending on site or telemedicine where the modality/location was not documented. Appeal with the attestation, time stamps, or visit documentation that proves direct patient contact.

How do I resolve a CARC 112 (CO-112) denial?

Start with the most common root cause: Service billed without documentation of direct patient contact. First step: Appeal with the clinical note showing direct patient contact, time stamps, and attending supervision where required. See the full remediation and appeal checklist on this page before filing a formal appeal.

Is CARC 112 patient responsibility?

No — CARC 112 is typically carried under CO (Contractual Obligation) or OA (Other Adjustment), which means it is the provider's responsibility, not the patient's. Do not bill the patient unless the 835 CAS group code is PR.

What does CARC 112 look like on an EOB or 835 remittance?

On the 835 ERA, CARC 112 appears in Loop 2110 CAS segment as "CAS*CO*112*{amount}". On a paper EOB the same code prints in the Adjustment/Denial Reason column with the X12 description: "Service not furnished directly to the patient and/or not documented." — usually paired with one or more RARC remark codes in the same remittance line for additional context.

Which RARC is paired with CARC 112?

CARC 112 is commonly observed with RARC M127, N30. The RARC narrows the reason — for example, pointing at a missing modifier, an LCD citation, or a specific policy. Fix the underlying CARC first; the RARC usually clears with the corrected claim.

Disclaimer

This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. X12 code descriptors are maintained by the X12 External Code Lists; always verify against the current X12 release and the payer's own published policy before submitting or appealing a claim.