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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 29 of 306 CARCs in Coverage / eligibility.

RankCodeDescription (X12)
#1CARC 16Claim/service lacks information or has submission/billing error(s).
#2CARC 45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
#5CARC 22This care may be covered by another payer per coordination of benefits.
#7CARC 204This service/equipment/drug is not covered under the patient's current benefit plan.
#9CARC 252An attachment/other documentation is required to adjudicate this claim/service.
#14CARC 109Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
#16CARC 119Benefit maximum for this time period or occurrence has been reached.
#19CARC 27Expenses incurred after coverage terminated.
#30CARC 31Patient cannot be identified as our insured.
#31CARC 55Procedure/treatment/drug is deemed experimental/investigational by the payer.
#42CARC B11The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.
#48CARC 177Patient has not met the required eligibility requirements.
#80CARC 279Services not provided by Preferred network providers.
#96CARC 183The referring provider is not eligible to refer the service billed.
#113CARC 47This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
#128CARC 100Payment made to patient/insured/responsible party.
#141CARC 140Patient/Insured health identification number and name do not match.
#161CARC 34Insured has no coverage for newborns.
#162CARC 51These are non-covered services because this is a pre-existing condition.
#164CARC 60Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.
#185CARC 153Service/procedure was provided as a result of an act of war.
#190CARC 159Service/procedure was provided as a result of terrorism.
#195CARC 171Payment is denied when performed/billed by this type of provider in this type of facility.
#205CARC 202Non-covered personal comfort or convenience services.
#209CARC 212Administrative surcharges are not covered.
#211CARC 215Based on subrogation of a third party settlement.
#230CARC 258Claim/service not covered when patient is in custody/incarcerated.
#240CARC 269Anesthesia not covered for this service/procedure.
#271CARC B1Non-covered visits.

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.