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CARC 62 · CO-62

CARC 62 Denial: Payment denied/reduced for absence of, or exceeded, pre-certification/authoriza… — How to Fix and Appeal

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

TL;DR

CARC 62 (X12 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization). CARC 62 denies/reduces payment for an auth-related issue.

Official X12 description

“Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.”

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 62 actually means

CARC 62 denies/reduces payment for an auth-related issue. Similar to CARC 197/198; pull the auth record and either submit the auth number or request a retro-auth.

Common root causes

  • No auth obtained.
  • Service exceeded the authorized scope.

Prevention checklist

  • Pre-auth workflow automation.
  • Live auth-tracker against delivered services.

Appeal strategy — step by step

Most CARC 62 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. 1Submit the auth number on a corrected claim or request retro-auth.
Sample appeal-letter language for CARC 62
[Provider letterhead] Re: Appeal of CARC 62 — Claim #{claim_number} Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} On {remittance_date} this claim was adjusted with CARC 62: "Payment denied/reduced for absence of, or exceeded, pre-certification/authorization." We respectfully request reconsideration. The X12 External Code List definition of CARC 62 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 62 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 62?

Search demand rank
#115

Out of 306 seeded CARCs, ranked by combined US monthly search volume for "CARC 62", "CO-62 denial", and "denial code 62".

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 62

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 62

What does CARC 62 mean?

CARC 62 is an X12 Claim Adjustment Reason Code. The official definition is: "Payment denied/reduced for absence of, or exceeded, pre-certification/authorization." In plain English, the payer is telling you cARC 62 denies/reduces payment for an auth-related issue. Similar to CARC 197/198; pull the auth record and either submit the auth number or request a retro-auth.

How do I resolve a CARC 62 (CO-62) denial?

Start with the most common root cause: No auth obtained. First step: Submit the auth number on a corrected claim or request retro-auth. See the full remediation and appeal checklist on this page before filing a formal appeal.

Is CARC 62 patient responsibility?

No — CARC 62 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 62 look like on an EOB or 835 remittance?

On the 835 ERA, CARC 62 appears in Loop 2110 CAS segment as "CAS*CO*62*{amount}". On a paper EOB the same code prints in the Adjustment/Denial Reason column with the X12 description: "Payment denied/reduced for absence of, or exceeded, pre-certification/authorization." — usually paired with one or more RARC remark codes in the same remittance line for additional context.

Which RARC is paired with CARC 62?

CARC 62 is commonly observed with RARC M62, N54. 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.