Official X12 description
“Payer deems the information submitted does not support this level of service.”
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 150 actually means
CARC 150 is a down-coding / level-of-service denial. The payer reviewed your claim (often through post-payment review or an automated E/M leveling tool) and concluded the documentation does not support the code you billed. The fix is almost always an appeal with the clinical record — provided the record actually supports the level billed under the applicable guidelines (2021 AMA E/M guidelines for office visits, 1995/1997 for other E/M categories where still in use).
Common root causes
- E/M leveled too high relative to the documented history, exam, or MDM (for 1995/1997 E/M) or MDM / time (for 2021 E/M).
- Hospital observation or inpatient admission without documentation of the clinical necessity for that level.
- Critical-care time not documented at the minute level.
- Unlisted procedure billed without a supporting report.
Prevention checklist
- E/M auditing program with provider-level feedback and targeted coaching for outliers.
- EHR-side E/M leveling tools should reference the 2021 AMA MDM / time guidelines, not outdated 1995/1997 tables, for office visits.
- Enforce required-attachment logic for unlisted codes and for critical-care time documentation.
Appeal strategy — step by step
Most CARC 150 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.
- 1Pull the office note, verify it supports the billed level under the applicable guidelines, and appeal with a leveling-worksheet citation.
- 2For commercial-payer down-coders (e.g., Optum/EncoderPro-based), request the algorithm's coverage criteria and rebut point-by-point.
- 3If the note genuinely does not support the billed level, accept the down-code and educate the provider rather than appealing a losing case.
Sample appeal-letter language for CARC 150
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 150 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 150?
Out of 306 seeded CARCs, ranked by combined US monthly search volume for "CARC 150", "CO-150 denial", and "denial code 150".
Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).
How QuickRCM prevents CARC 150
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.
CAQH CORE code combinations for CARC 150
Under the CAQH CORE Payment and Remittance Uniform Use rule, health plans may pair CARC 150 only with the remark codes and group codes below for the defined business scenario 3 (Billed service not covered by the health plan). A combination outside this list on an 835 is itself a payer compliance issue worth raising.
| RARC | Remark description | Group code | Scenario |
|---|---|---|---|
| (no RARC) | CARC used without a remark code | CO, PI or PR | 3 |
| M25 | The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment. | CO, PI or PR | 3 |
| M26 | The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service /any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office. | CO, PI or PR | 3 |
| N10 | Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. | CO, PI or PR | 3 |
| N45 | Payment based on authorized amount. | CO, PI or PR | 3 |
| N115 | This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD. | CO, PI or PR | 3 |
| N124 | Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay. | PR | 3 |
| N125 | Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice. The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office. | CO or PI | 3 |
| N163 | Medical record does not support code billed per the code definition. | CO, PI or PR | 3 |
| N180 | This item or service does not meet the criteria for the category under which it was billed. | CO, PI or PR | 3 |
| N205 | Information provided was illegible. | CO, PI or PR | 3 |
| N640 | Exceeds number/frequency approved/allowed within time period. | CO, PI or PR | 3 |
Frequently asked questions — CARC 150
What does CARC 150 mean?
CARC 150 is an X12 Claim Adjustment Reason Code. The official definition is: "Payer deems the information submitted does not support this level of service." In plain English, the payer is telling you cARC 150 is a down-coding / level-of-service denial. The payer reviewed your claim (often through post-payment review or an automated E/M leveling tool) and concluded the documentation does not support the code you billed. The fix is almost always an appeal with the clinical record — provided the record actually supports the level billed under the applicable guidelines (2021 AMA E/M guidelines for office visits, 1995/1997 for other E/M categories where still in use).
How do I resolve a CARC 150 (CO-150) denial?
Start with the most common root cause: E/M leveled too high relative to the documented history, exam, or MDM (for 1995/1997 E/M) or MDM / time (for 2021 E/M). First step: Pull the office note, verify it supports the billed level under the applicable guidelines, and appeal with a leveling-worksheet citation. See the full remediation and appeal checklist on this page before filing a formal appeal.
Is CARC 150 patient responsibility?
No — CARC 150 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 150 look like on an EOB or 835 remittance?
On the 835 ERA, CARC 150 appears in Loop 2110 CAS segment as "CAS*CO*150*{amount}". On a paper EOB the same code prints in the Adjustment/Denial Reason column with the X12 description: "Payer deems the information submitted does not support this level of service." — usually paired with one or more RARC remark codes in the same remittance line for additional context.
Which RARC is paired with CARC 150?
CARC 150 is commonly observed with RARC M25, N115. 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.