CARC and RARC denial code lookup
Find a claim adjustment reason code or remittance advice remark code, then open its reference guide for root causes, prevention, resolution steps, and source citations.
CARCs explain an adjustment; RARCs add context. A remark code does not necessarily indicate a denial. Verify the full remittance, current payer instructions, and applicable deadlines before taking action.
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506 matching codes. Page 1 of 21.
| Code | Meaning | Starting point |
|---|---|---|
| CARC 1 | CARC 1 is not a denial — it tells you the payer applied the billed amount to the patient's annual deductible, so the patient (not the payer) is responsible for that portion. This appears routinely on 835s at the start of the plan year. There is nothing to appeal and nothing to rework on the claim itself; the line moves to patient responsibility and should be billed to the patient or their secondary coverage. | Not appealable — CARC 1 is a contractual patient responsibility per plan design. |
| CARC 2 | CARC 2 is not a denial — it tells you the payer applied the billed amount to the patient's coinsurance. The line is patient responsibility under the plan's benefit design (commonly 20% of allowed for Medicare Part B). Bill the patient or their secondary/supplemental coverage; no appeal path. | Not appealable — coinsurance is contractual patient responsibility. |
| CARC 3 | CARC 3 is informational, not a denial — the payer applied the patient's plan-defined copayment to the service. The copay is patient responsibility; collect at time of service if possible, otherwise include in the patient statement. | Not appealable — copay is contractual patient responsibility. |
| CARC 4 | CARC 4 means the procedure code and its modifier(s) do not line up — either a modifier that the payer requires for this code was not submitted, or the modifier that was submitted is not valid for that procedure. This is a technical denial, almost always fixable with a corrected claim rather than an appeal. Common culprits are missing modifier 25 on an E/M billed with a minor procedure, missing modifier 59 (or X{EPSU}) on a distinct service, and incorrect laterality modifiers (LT, RT, 50). | First, determine whether a corrected claim (not an appeal) is the right path — most CARC 4 denials clear with a rebill once the modifier is added. |
| CARC 5 | CARC 5 indicates the CPT/HCPCS billed is not valid for the Place of Service (POS) code submitted — for example, a facility-only procedure billed with office POS 11, or a surgical code billed with POS 21 (inpatient) when it should have been POS 22 (outpatient). Correct the POS or the procedure and rebill. | Correct the POS/TOB and submit a corrected claim — no narrative appeal needed. |
| CARC 6 | CARC 6 denies because the CPT/HCPCS or revenue code is not valid for the patient's age — e.g., an adult-only procedure on a pediatric patient. Usually a coding error; fix the code and resubmit. | Recode to an age-appropriate procedure and submit a corrected claim. |
| CARC 7 | CARC 7 denies because the procedure is gender-specific and doesn't match the patient's gender on file — e.g., a Pap smear billed on a male patient. Often a coding or registration error; fix the gender or the code and resubmit. | If gender is wrong on record, update via the 270/271 demographic correction flow. |
| CARC 8 | CARC 8 denies the line because the procedure is not valid for the provider's taxonomy — for example a mental-health CPT billed by a primary-care taxonomy, or a surgical CPT billed by an evaluation-only specialist. Confirm the provider's taxonomy is correct on file; if wrong, update and rebill; if right, rebill under a correctly credentialed provider. | Update taxonomy with the payer and submit a corrected claim. |
| CARC 9 | CARC 9 denies because the ICD-10 diagnosis submitted doesn't match the patient's age per the payer's edits — pediatric diagnosis on an adult, geriatric diagnosis on a child. Fix the ICD (often a coding error or incorrect code selection) and resubmit. | Recode to an age-appropriate ICD-10 and submit a corrected claim. |
| CARC 10 | CARC 10 denies because the ICD-10 is gender-specific and doesn't align with the patient's gender on file. Usually a coding or registration error; correct and resubmit. | Recode or correct gender on record, then submit a corrected claim. |
| CARC 11 | CARC 11 means the payer's medical-necessity edit does not connect the ICD-10 diagnosis you submitted to the CPT/HCPCS procedure you billed. Either the diagnosis does not appear on the payer's covered diagnosis list for this procedure (a Local Coverage Determination or Medical Policy), the diagnosis was truncated or coded at the wrong specificity, or the diagnosis linkage on the 837 was wrong. This usually clears with a corrected claim once the right diagnosis is linked; a true appeal is only warranted when the clinical record supports a covered diagnosis that was not originally coded. | If a correctly coded, covered diagnosis exists in the chart but was not on the original claim, submit a corrected claim rather than an appeal. |
| CARC 12 | CARC 12 denies because the diagnosis isn't within the scope of the billing provider's specialty — a dental ICD billed by a medical provider, or a mental-health ICD billed by a non-behavioral specialty. | Correct the taxonomy or rebill from the correctly-scoped provider. |
| CARC 13 | CARC 13 denies because the payer's records show the member died before the DOS — typically a data error (DOS on the claim is wrong, or the payer has an incorrect date-of-death). Verify DOS and date-of-death via the payer portal, correct, and resubmit. | Correct the DOS on the claim or work with the payer to fix the DOD in their system. |
| CARC 14 | CARC 14 denies because the patient's DOB on the claim is after the DOS — a data-integrity issue. Fix the DOB on the claim (and possibly in the registration record) and rebill. | Correct the DOB and submit a corrected claim. |
| CARC 15 | CARC 15 is an auth-number validation denial — the number on the claim doesn't validate to the payer's system, is missing entirely, or doesn't match the billed code/provider. This pairs closely with RARC M62. Pull the correct auth number and resubmit a corrected claim. | Submit a corrected claim with the right auth number. |
| CARC 16 | CARC 16 is the industry's most common catch-all denial: the claim is technically incomplete or contains a data error that prevents adjudication. The specific problem is almost always spelled out in the accompanying RARC(s) — if the 835 carries CARC 16 alone with no RARC, rework is blind. Examples include a missing referring provider NPI, an invalid place-of-service code, a blank accident indicator, or a missing required claim attachment. Correct the error and rebill; true appeal is rarely necessary. | Read the accompanying RARC carefully — the RARC tells you exactly what is missing. If none is present, call the payer for clarification before working the denial. |
| CARC 18 | CARC 18 means the payer already has an identical claim or line in their system for the same patient, provider, date of service, and procedure. The duplicate is usually benign — a clearinghouse retransmit, a practice-management auto-rebill, or an accidental second submission — but it can also be a legitimate second service on the same day that needs a distinct-procedure modifier to be recognized. Start by confirming whether the original claim paid; if it did, no action is needed beyond suppressing the duplicate from rework queues. | If the original claim already paid, no appeal is needed — close the duplicate denial in the workqueue. |
| CARC 19 | CARC 19 tells you the health plan considers the encounter a work-related injury or illness and thus the financial responsibility of the patient's workers' compensation carrier, not the health plan. Before rebilling, confirm the injury mechanism and employment status, then redirect the claim to the employer's workers' comp insurer with the WC claim number. If the patient or employer disputes the WC determination, obtain a WC denial (WC-1A or equivalent state form) before rebilling to the health plan. | Rebill to the workers' compensation carrier with the WC claim number, date of injury, and employer details. |
| CARC 20 | CARC 20 indicates the payer believes the service relates to an injury with active liability coverage (auto, homeowners, or third-party injury case). Rebill the liability carrier; the health plan typically only pays after the liability policy exhausts or denies. Subrogation may apply. | Rebill the liability carrier. |
| CARC 21 | CARC 21 indicates the payer believes the service is for an injury covered by the patient's no-fault auto carrier (PIP/MedPay). Rebill the auto carrier with a PIP claim number, then come back to the health plan only after the no-fault benefits are exhausted (with a PIP exhaust letter). | Rebill the auto carrier with the PIP claim number and accident details. |
| CARC 22 | CARC 22 means the payer believes another insurer is primary for this patient and is not paying until you confirm. This is a coordination-of-benefits (COB) issue, not a medical-necessity or coding issue. Usually the patient has active secondary coverage the payer knows about, or a workers-comp / motor-vehicle / third-party-liability flag, and the payer wants the primary EOB on file before they'll adjudicate. The fix is to verify the correct primary, rebill the correct primary first, then rebill this payer as secondary with the primary EOB. | If the payer is correct about another primary, rebill the primary first, then submit this payer as secondary with the primary's 835 or paper EOB. |
| CARC 23 | CARC 23 is not a denial — it's an accounting entry on a secondary/tertiary 835 showing the impact of what the primary payer already paid or adjusted. It keeps the ledger balanced so the sum of payments, adjustments, and patient responsibility reconciles with the original billed amount. No action is required other than posting the adjustment accurately. | Not an appealable denial. If the amount the secondary paid seems wrong after accounting for the primary, reconcile against the secondary's COB formula (pay-the-difference, maintenance-of-benefits, or non-duplication) rather than appealing CARC 23 directly. |
| CARC 24 | CARC 24 means the payer considers the service to be included in a capitation payment (a fixed per-member-per-month payment to a provider group or IPA), so no fee-for-service payment will be issued for this claim. It can also appear when a patient is assigned to a capitated medical group and the claim was routed outside that group. The action is usually to redirect the claim to the capitated group or to accept the write-off if capitation is the correct contracted arrangement. | If the patient is not in your capitated group and was incorrectly assigned, work with the health plan's provider relations to correct the assignment, then rebill. |
| CARC 26 | CARC 26 tells you the service date fell before the member's coverage effective date — this is an eligibility denial, not a medical one. Verify effective-date history; if the coverage truly was not in effect, the balance shifts to the patient or a prior payer. | If coverage was active on the DOS, appeal with an eligibility screenshot/export from the payer portal for the exact date. |
| CARC 27 | CARC 27 means the patient was not insured by this payer on the date of service. Either the policy had terminated, the patient had moved to a different plan, or the eligibility record the payer has does not reflect coverage on that date. Verify the patient's actual coverage for the DOS; if the patient had different coverage, rebill the correct payer. If the patient was genuinely uninsured on that date, the balance becomes self-pay. | If the patient had different active coverage on the DOS, rebill that payer; no appeal of CARC 27 is needed. |
Maintained from the existing QuickIntell reference registry. Official lists: X12 CARC and X12 RARC. This tool is an operational reference, not a coverage determination.