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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 20 of 306 CARCs in Patient responsibility.

RankCodeDescription (X12)
#18CARC 23The impact of prior payer(s) adjudication including payments and/or adjustments.
#28CARC 242Services not provided by network/primary care providers.
#39CARC 256Service not payable per managed care contract.
#51CARC 1Deductible Amount
#54CARC 2Coinsurance Amount.
#62CARC 200Expenses incurred during lapse in coverage.
#69CARC 3Co-payment Amount.
#109CARC 35Lifetime benefit maximum has been reached.
#117CARC 66Blood Deductible.
#135CARC 111Not covered unless the provider accepts assignment.
#142CARC 149Lifetime benefit maximum has been reached for this service/benefit category.
#158CARC 275Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered.
#169CARC 106Patient payment option/election not in effect.
#181CARC 142Monthly Medicaid patient liability amount.
#223CARC 241Low Income Subsidy (LIS) Co-payment Amount.
#225CARC 247Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
#226CARC 248Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
#246CARC 281Deductible waived per contractual agreement.
#249CARC 289Services considered under the dental and medical plans, benefits not available.
#262CARC 303Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered for Qualified Medicare and Medicaid Beneficiaries.

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.