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 April 23, 2026

Updated Apr 23, 2026

All CARCs306 Bundling / NCCI8 Coding / modifier18 Medical necessity8 Prior authorization15 Coverage / eligibility29 Timely filing2 Patient responsibility20 Duplicate2 Contractual21 Other183

Showing 183 of 306 CARCs in Other.

Rank	Code	Description (X12)	Category	US search / mo
#12	CARC B7	This provider was not certified/eligible to be paid for this procedure/service on this date of service.	Other	320
#15	CARC A1	Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Other	260
#21	CARC 24	Charges are covered under a capitation agreement/managed care plan.	Other	210
#22	CARC 226	Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete.	Other	180
#23	CARC 227	Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete.	Other	170
#24	CARC 151	Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.	Other	170
#33	CARC 26	Expenses incurred prior to coverage.	Other	80
#34	CARC 150	Payer deems the information submitted does not support this level of service.	Other	70
#35	CARC 107	The related or qualifying claim/service was not identified on this claim.	Other	70
#36	CARC 129	Prior processing information appears incorrect.	Other	70
#37	CARC 39	Services denied at the time authorization/pre-certification was requested.	Other	70
#40	CARC 272	Coverage/program guidelines were not met.	Other	70
#43	CARC 5	The procedure code/type of bill is inconsistent with the place of service.	Other	60
#47	CARC 170	Payment is denied when performed/billed by this type of provider.	Other	50
#49	CARC 216	Based on the findings of a review organization.	Other	50
#52	CARC 181	Procedure code was invalid on the date of service.	Other	40
#56	CARC 95	Plan procedures not followed.	Other	40
#58	CARC 133	The disposition of this service line is pending further review.	Other	40
#59	CARC 185	The rendering provider is not eligible to perform the service billed.	Other	40
#60	CARC 193	Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.	Other	40
#61	CARC 198	Precertification/notification/authorization/pre-treatment exceeded.	Other	40
#65	CARC 286	Appeal procedures not followed.	Other	40
#66	CARC B16	'New Patient' qualifications were not met.	Other	40
#67	CARC 32	Our records indicate that this dependent is not an eligible dependent as defined.	Other	30
#68	CARC 21	This injury/illness is the liability of the no-fault carrier.	Other	30
#70	CARC 146	Diagnosis was invalid for the date(s) of service reported.	Other	30
#71	CARC 147	Provider contracted/negotiated rate expired or not on file.	Other	30
#72	CARC 163	Attachment/other documentation referenced on the claim was not received.	Other	30
#73	CARC 208	National Provider Identifier - Not matched.	Other	30
#74	CARC 251	The attachment/other documentation that was received was incomplete or deficient.	Other	30
#75	CARC 58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.	Other	30
#78	CARC 19	This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.	Other	30
#82	CARC 40	Charges do not meet qualifications for emergent/urgent care.	Other	20
#85	CARC 20	This injury/illness is covered by the liability carrier.	Other	20
#86	CARC 6	The procedure/revenue code is inconsistent with the patient's age.	Other	20
#89	CARC 206	National Provider Identifier - missing.	Other	20
#90	CARC 246	This non-payable code is for required reporting only.	Other	20
#92	CARC 56	Procedure/treatment has not been deemed 'proven to be effective' by the payer.	Other	20
#93	CARC 125	Submission/billing error(s). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Other	10
#94	CARC 7	The procedure/revenue code is inconsistent with the patient's gender.	Other	10
#95	CARC 30	Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.	Other	10
#97	CARC 187	Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.).	Other	10
#98	CARC 201	Workers' Compensation case settled. Patient is responsible for amount of this claim/service through Workers' Compensation 'Medicare set-aside arrangement' or other agreement.	Other	10
#99	CARC 261	The procedure or service is inconsistent with the patient's history.	Other	10
#101	CARC 285	Appeal procedures not followed.	Other	10
#107	CARC 13	The date of death precedes the date of service.	Other	—
#108	CARC 14	The date of birth follows the date of service.	Other	—
#112	CARC 44	Prompt-pay discount.	Other	—
#114	CARC 52	The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.	Other	—
#115	CARC 62	Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.	Other	—
#116	CARC 65	Procedure code was incorrect. This payment reflects the correct code.	Other	—
#118	CARC 70	Cost outlier - Adjustment to compensate for additional costs.	Other	—
#119	CARC 74	Indirect Medical Education Adjustment.	Other	—
#120	CARC 75	Direct Medical Education Adjustment.	Other	—
#121	CARC 77	Covered days.	Other	—
#123	CARC 87	Transfer amount.	Other	—
#124	CARC 88	Adjustment amount represents collection against receivable created in prior overpayment.	Other	—
#125	CARC 89	Professional fees removed from charges.	Other	—
#126	CARC 90	Ingredient cost adjustment.	Other	—
#127	CARC 91	Dispensing fee adjustment.	Other	—
#129	CARC 101	Predetermination: anticipated payment upon completion of services or claim adjudication.	Other	—
#130	CARC 102	Major Medical Adjustment.	Other	—
#131	CARC 103	Provider promotional discount (e.g., Senior citizen discount).	Other	—
#132	CARC 104	Managed care withholding.	Other	—
#133	CARC 105	Tax withholding.	Other	—
#136	CARC 114	Procedure/product not approved by the Food and Drug Administration.	Other	—
#137	CARC 115	Procedure postponed, canceled, or delayed.	Other	—
#138	CARC 116	The advance indemnification notice signed by the patient did not comply with requirements.	Other	—
#139	CARC 122	Psychiatric reduction.	Other	—
#143	CARC 152	Payer deems the information submitted does not support this length of service.	Other	—
#144	CARC 166	These services were submitted after this payer's responsibility for processing claims under this plan ended.	Other	—
#145	CARC 168	Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan.	Other	—
#146	CARC 178	Payment adjusted because the patient has not met the required spend down requirements.	Other	—
#147	CARC 180	Patient has not met the required residency requirements.	Other	—
#148	CARC 186	Level of care change adjustment.	Other	—
#149	CARC 188	This product/procedure is only covered when used according to FDA recommendations.	Other	—
#150	CARC 190	Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.	Other	—
#151	CARC 192	Non standard adjustment code from paper remittance.	Other	—
#152	CARC 205	Pharmacy discount card processing fee.	Other	—
#154	CARC 219	Based on extent of injury.	Other	—
#156	CARC 229	Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X.	Other	—
#157	CARC 249	This claim has been identified as a readmission.	Other	—
#159	CARC A5	Medicare Claim PPS Capital Cost Outlier Amount.	Other	—
#160	CARC 33	Insured has no dependent coverage.	Other	—
#165	CARC 61	Adjustment for failure to obtain second surgical opinion.	Other	—
#166	CARC 69	Day outlier amount.	Other	—
#167	CARC 76	Disproportionate Share Adjustment.	Other	—
#168	CARC 85	Patient Interest Adjustment (Use Only Group code PR).	Other	—
#170	CARC 110	Billing date predates service date.	Other	—
#171	CARC 112	Service not furnished directly to the patient and/or not documented.	Other	—
#172	CARC 117	Transportation is only covered to the closest facility that can provide the necessary care.	Other	—
#173	CARC 118	ESRD network support adjustment.	Other	—
#174	CARC 121	Indemnification adjustment - compensation for outstanding member responsibility.	Other	—
#175	CARC 130	Claim submission fee.	Other	—
#176	CARC 132	Prearranged demonstration project adjustment.	Other	—
#178	CARC 135	Interim bills cannot be processed.	Other	—
#179	CARC 137	Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.	Other	—
#180	CARC 139	Contracted funding agreement - Subscriber is employed by the provider of services.	Other	—
#183	CARC 144	Incentive adjustment, e.g. preferred product/service.	Other	—
#186	CARC 154	Payer deems the information submitted does not support this dosage.	Other	—
#187	CARC 155	Patient refused the service/procedure.	Other	—
#188	CARC 157	Service/procedure was provided as a result of an act of war.	Other	—
#189	CARC 158	Service/procedure was provided outside of the United States.	Other	—
#191	CARC 160	Injury/illness was the result of an activity that is a benefit exclusion.	Other	—
#192	CARC 161	Provider performance bonus.	Other	—
#194	CARC 169	Alternate benefit has been provided.	Other	—
#196	CARC 172	Payment is adjusted when performed/billed by a provider of this specialty.	Other	—
#197	CARC 173	Service/equipment was not prescribed by a physician.	Other	—
#198	CARC 174	Service was not prescribed prior to delivery.	Other	—
#199	CARC 175	Prescription is incomplete.	Other	—
#200	CARC 176	Prescription is not current.	Other	—
#201	CARC 179	Patient has not met the required waiting requirements.	Other	—
#202	CARC 184	The prescribing/ordering provider is not eligible to prescribe/order the service billed.	Other	—
#203	CARC 189	'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific code available.	Other	—
#204	CARC 199	Revenue code and Procedure code do not match.	Other	—
#207	CARC 207	National Provider Identifier - Invalid format.	Other	—
#208	CARC 211	National Drug Code (NDC) is not eligible for rebate.	Other	—
#212	CARC 223	Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.	Other	—
#213	CARC 224	Patient identification compromised by identity theft. Identity verification required for processing this and future claims.	Other	—
#214	CARC 225	Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837).	Other	—
#215	CARC 228	Denied for failure of this provider, payer or subscriber to supply requested information to a previous payer for their adjudication.	Other	—
#216	CARC 232	Institutional Transfer Amount.	Other	—
#217	CARC 233	Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.	Other	—
#218	CARC 235	Sales Tax.	Other	—
#219	CARC 237	Legislated/Regulatory Penalty.	Other	—
#220	CARC 238	Claim spans eligible and ineligible periods of coverage.	Other	—
#221	CARC 239	Claim spans eligible and ineligible periods of coverage. Rebill separate claims.	Other	—
#224	CARC 245	Provider performance program withhold.	Other	—
#227	CARC 250	The attachment/other documentation that was received was the incorrect attachment/document.	Other	—
#228	CARC 254	Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.	Other	—
#229	CARC 257	The disposition of the related Property & Casualty claim (injury or illness) is pending due to the Payer's active grace period (as defined by State/Federal laws).	Other	—
#231	CARC 259	Additional payment for Dental/Vision service utilization.	Other	—
#233	CARC 262	Adjustment for delivery cost.	Other	—
#234	CARC 263	Adjustment for shipping cost.	Other	—
#235	CARC 264	Adjustment for postage cost.	Other	—
#236	CARC 265	Adjustment for administrative cost.	Other	—
#237	CARC 266	Adjustment for compound preparation cost.	Other	—
#238	CARC 267	Claim/service spans multiple months.	Other	—
#239	CARC 268	The Claim spans two calendar years. Please resubmit one claim per calendar year.	Other	—
#241	CARC 270	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's dental plan for further consideration.	Other	—
#244	CARC 278	Performance program proficiency requirements not met.	Other	—
#245	CARC 280	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's pharmacy plan for further consideration.	Other	—
#247	CARC 282	The procedure/revenue code is inconsistent with the type of bill.	Other	—
#248	CARC 283	Attending provider is not eligible to provide direction of care.	Other	—
#250	CARC 290	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's dental plan for further consideration.	Other	—
#251	CARC 291	Claim received by the dental plan, but benefits not available under this plan. Claim has been forwarded to the patient's medical plan for further consideration.	Other	—
#252	CARC 292	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's pharmacy plan for further consideration.	Other	—
#253	CARC 293	Payment made to employer.	Other	—
#254	CARC 294	Payment made to attorney.	Other	—
#255	CARC 295	Pharmacy Direct/Indirect Remuneration (DIR).	Other	—
#257	CARC 297	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's vision plan for further consideration.	Other	—
#258	CARC 298	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's vision plan for further consideration.	Other	—
#259	CARC 299	The billing provider is not eligible to receive payment for the service billed.	Other	—
#260	CARC 300	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration.	Other	—
#261	CARC 301	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's Behavioral Health Plan for further consideration.	Other	—
#263	CARC 304	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's hearing plan for further consideration.	Other	—
#264	CARC 305	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's hearing plan for further consideration.	Other	—
#265	CARC 306	Type of bill is inconsistent with patient status.	Other	—
#266	CARC 307	Payment adjusted based on the Medicare Maximum Fair Price Standard.	Other	—
#268	CARC A0	Patient refund amount.	Other	—
#269	CARC A6	Prior hospitalization or 30 day transfer requirement not met.	Other	—
#270	CARC A8	Ungroupable DRG.	Other	—
#272	CARC B4	Late filing penalty.	Other	—
#273	CARC B12	Services not documented in patient's medical records.	Other	—
#275	CARC B23	Procedure billed is not authorized per the Clinical Laboratory Improvement Amendment (CLIA) proficiency test.	Other	—
#277	CARC P2	Not a work related injury/illness and thus not the liability of the workers' compensation carrier.	Other	—
#278	CARC P3	Workers' Compensation case settled, patient is responsible for further charges.	Other	—
#281	CARC P6	Based on entitlement to benefits.	Other	—
#284	CARC P9	No available or correlating CPT/HCPCS code to describe this service.	Other	—
#285	CARC P10	Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation.	Other	—
#286	CARC P11	The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements.	Other	—
#288	CARC P13	Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies.	Other	—
#289	CARC P15	Workers' Compensation Medical Treatment Guideline Adjustment.	Other	—
#290	CARC P16	Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.	Other	—
#294	CARC P20	Service not paid under jurisdictional regulations or payment policies for outpatient facility.	Other	—
#295	CARC P21	Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations.	Other	—
#296	CARC P22	Payment adjusted based on MPC or PIP Benefits jurisdictional regulations.	Other	—
#299	CARC P25	Payment adjusted based on Medical Provider Network (MPN).	Other	—
#301	CARC P27	Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies.	Other	—
#302	CARC P28	Payment adjusted based on Liability Coverage Benefits jurisdictional regulations and/or payment policies.	Other	—
#304	CARC P30	Exacerbation of previous condition denied due to incomplete medical documentation.	Other	—
#305	CARC P31	Exacerbation of previous condition denied due to treatment exceeding time limits.	Other	—
#306	CARC P32	Payment adjusted due to Apportionment as determined by the Workers' Compensation jurisdictional regulations.	Other	—

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.

CARC — Claim Adjustment Reason Codes

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Paired with a RARC?