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CARC — Claim Adjustment Reason Codes

CARCs appear in the 835 remittance advice CAS segment and tell you why the payer paid less than the billed amount — bundling, medical necessity, prior-auth gaps, timely-filing, patient responsibility, and contractual adjustments. 306 codes seeded, ordered by US search demand. Every leaf page cites the official X12 description and pairs the RARC partners typically observed on the 835. Source: X12 External Code Lists.

Reviewed by QuickIntell Editorial Team · Last reviewed

Updated

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All CARCs306Bundling / NCCI8Coding / modifier18Medical necessity8Prior authorization15Coverage / eligibility29Timely filing2Patient responsibility20Duplicate2Contractual21Other183

Showing 18 of 306 CARCs in Coding / modifier.

RankCodeDescription (X12)
#13CARC 4The procedure code is inconsistent with the modifier used or a required modifier is missing.
#29CARC 234This procedure is not paid separately.
#32CARC 236This procedure or procedure/modifier combination is not compatible with another procedure/procedure/modifier combination provided on the same day according to the National Correct…
#45CARC 231Mutually exclusive procedures cannot be done in the same day/setting.
#46CARC 49This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam.
#53CARC B9Patient is enrolled in a Hospice.
#55CARC 8The procedure code is inconsistent with the provider type/specialty (taxonomy).
#77CARC B20Procedure/service was partially or fully furnished by another provider.
#81CARC 54Multiple physicians/assistants are not covered in this case.
#83CARC 9The diagnosis is inconsistent with the patient's age.
#88CARC 182Procedure modifier was invalid on the date of service.
#105CARC 10The diagnosis is inconsistent with the patient's gender.
#106CARC 12The diagnosis is inconsistent with the provider type.
#134CARC 108Rent/purchase guidelines were not met.
#177CARC 134Technical fees removed from charges.
#206CARC 203Discontinued or reduced service.
#222CARC 240The diagnosis is inconsistent with the patient's birth weight.
#274CARC B14Only one visit or consultation per physician per day is covered.

Paired with a RARC?

Most CARCs arrive on the 835 alongside one or more Remittance Advice Remark Codes that narrow the reason. See the RARC remark-code reference for the paired explanations.