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.
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Showing 8 of 306 CARCs in Medical necessity.
| Rank | Code | Description (X12) | Category | US search / mo |
|---|---|---|---|---|
| #3 | CARC 96 | Non-covered charge(s). | Medical necessity | 570 |
| #6 | CARC 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer. | Medical necessity | 400 |
| #27 | CARC 11 | The diagnosis is inconsistent with the procedure. | Medical necessity | 120 |
| #44 | CARC 167 | This (these) diagnosis(es) is (are) not covered. | Medical necessity | 50 |
| #63 | CARC 273 | Coverage/program guidelines were exceeded. | Medical necessity | 40 |
| #91 | CARC 276 | Services denied by the prior payer(s) are not covered by this payer. | Medical necessity | 20 |
| #122 | CARC 78 | Non-Covered days/Room charge adjustment. | Medical necessity | — |
| #283 | CARC P8 | Claim is under investigation. | Medical necessity | — |
Tools for the reason codes in this directory
Bundling, unit and medical-necessity adjustments can be checked against CMS data before you work the denial.
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.