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Denial Code Library
Common medical-billing claim-adjustment reason codes (CARC), in plain English — what each means, why it happens, and how it's worked toward payment. Built by Apex Flow's denial-recovery team.
- CARC 4 — Procedure code inconsistent with the modifier (or a required modifier is missing)
- CARC 11 — The diagnosis is inconsistent with the procedure
- CARC 16 — Claim/service lacks information or has submission/billing error(s)
- CARC 18 — Exact duplicate claim or service
- CARC 22 — This care may be covered by another payer per coordination of benefits
- CARC 24 — Charges are covered under a capitation agreement / managed care plan
- CARC 27 — Expenses incurred after coverage terminated
- CARC 29 — The time limit for filing the claim has expired
- CARC 45 — Charge exceeds the fee schedule / maximum allowable or contracted amount
- CARC 50 — Non-covered services — not deemed a 'medical necessity' by the payer
- CARC 96 — Non-covered charge(s)
- CARC 97 — The benefit for this service is included in another service already adjudicated (bundling)
- CARC 109 — Claim/service not covered by this payer — send to the correct payer
- CARC 119 — Benefit maximum for this time period or occurrence has been reached
- CARC 151 — Payer deems the information submitted doesn't support this many/frequency of services
- CARC 167 — This (these) diagnosis(es) is (are) not covered
- CARC 197 — Precertification / authorization / notification absent
- CARC 198 — Precertification / authorization exceeded
- CARC 204 — This service/equipment/drug is not covered under the patient's current benefit plan
- CARC 234 — This procedure is not paid separately
- CARC 252 — An attachment / other documentation is required to adjudicate the claim
- CARC B7 — This provider was not certified/eligible to be paid for this service on this date