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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

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

Showing 21 of 306 CARCs in Contractual.

RankCodeDescription (X12)
#38CARC 253Sequestration - reduction in federal payment.
#50CARC 222Exceeds the contracted maximum number of hours/days/units by this provider for this period.
#57CARC 131Claim specific negotiated discount.
#79CARC 94Processed in Excess of charges.
#100CARC 209Per regulatory or other agreement, the provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected.
#110CARC 41Discount agreed to in Preferred Provider contract.
#111CARC 42Charges exceed our fee schedule or maximum allowable amount.
#182CARC 143Portion of payment deferred.
#232CARC 260Processed under Medicaid ACA Enhanced Fee Schedule.
#242CARC 271Prior contractual reductions related to a current periodic payment as part of a contractual agreement.
#267CARC 308Adjustment based on contracted funding agreement rate vs the amount billed for the service.
#276CARC P1State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.
#280CARC P5Based on payer reasonable and customary fees. No maximum allowable defined by legislative fee arrangement.
#282CARC P7The applicable fee schedule/fee database does not contain the billed code.
#287CARC P12Workers' compensation jurisdictional fee schedule adjustment.
#292CARC P18Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service.
#293CARC P19Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due.
#297CARC P23Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment.
#298CARC P24Payment adjusted based on Preferred Provider Organization (PPO).
#300CARC P26Payment adjusted based on Voluntary Provider network (VPN).
#303CARC P29Liability Benefits jurisdictional fee schedule adjustment.

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.