Official X12 description
“Anesthesia not covered for this service/procedure.”
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 269 actually means
CARC 269 denies anesthesia charges because the payer's policy excludes anesthesia for the billed procedure (e.g., screening colonoscopy anesthesia in certain plans). Verify policy and appeal with medical-necessity documentation.
Common root causes
- Payer's anesthesia policy excludes for this procedure.
Prevention checklist
- Procedure-specific anesthesia coverage check at scheduling.
Appeal strategy — step by step
Most CARC 269 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.
- 1Appeal with medical-necessity rationale for anesthesia on the specific procedure.
Sample appeal-letter language for CARC 269
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 269 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 269?
Out of 306 seeded CARCs, ranked by combined US monthly search volume for "CARC 269", "CO-269 denial", and "denial code 269".
Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).
How QuickRCM prevents CARC 269
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 269
Under the CAQH CORE Payment and Remittance Uniform Use rule, health plans may pair CARC 269 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 |
| M37 | Not covered when the patient is under age 35. | CO, PI or PR | 3 |
| M82 | Service is not covered when patient is under age 50. | CO, PI or PR | 3 |
| M83 | Service is not covered unless the patient is classified as at high risk. | CO, PI or PR | 3 |
| M89 | Not covered more than once under age 40. | 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 |
| N30 | Patient ineligible for this service. | CO, PI or PR | 3 |
| N54 | Claim information is inconsistent with pre-certified/authorized services. | CO, PI or PR | 3 |
| N96 | Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur. | 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 |
| N129 | Not eligible due to the patient's age. | CO, PI or PR | 3 |
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. | CO, PI or PR | 3 |
| N906 | Service is not covered when a patient is under age 45. | CO, PI or PR | 3 |
Frequently asked questions — CARC 269
What does CARC 269 mean?
CARC 269 is an X12 Claim Adjustment Reason Code. The official definition is: "Anesthesia not covered for this service/procedure." In plain English, the payer is telling you cARC 269 denies anesthesia charges because the payer's policy excludes anesthesia for the billed procedure (e.g., screening colonoscopy anesthesia in certain plans). Verify policy and appeal with medical-necessity documentation.
How do I resolve a CARC 269 (CO-269) denial?
Start with the most common root cause: Payer's anesthesia policy excludes for this procedure. First step: Appeal with medical-necessity rationale for anesthesia on the specific procedure. See the full remediation and appeal checklist on this page before filing a formal appeal.
Is CARC 269 patient responsibility?
No — CARC 269 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 269 look like on an EOB or 835 remittance?
On the 835 ERA, CARC 269 appears in Loop 2110 CAS segment as "CAS*CO*269*{amount}". On a paper EOB the same code prints in the Adjustment/Denial Reason column with the X12 description: "Anesthesia not covered for this service/procedure." — usually paired with one or more RARC remark codes in the same remittance line for additional context.
Can CARC 269 be appealed successfully?
Yes — when the root cause does not apply to the specific claim. Overturn rates are strongest when the appeal cites the X12 definition, the payer's own published policy, and documentation that rebuts the payer's rationale. The sample appeal language block above is a starting point; always adapt it to the payer's reconsideration form.
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.