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Denial Code CARC 198: Precertification / authorization exceeded

CARC 198 means: precertification / authorization exceeded. Here's what it means in plain English, why it happens, and how it's worked toward payment.

Why you get a CARC 198 denial

• More units/visits were delivered than the authorization covered.
• The auth covered a different code or date range.
• Additional medically necessary services weren't separately authorized.

How to fix or appeal CARC 198

1. Compare the authorized units/dates to what was billed.
2. Request additional authorization for the excess where clinically justified.
3. Appeal with clinical documentation supporting the additional services.

Recoverable when the additional services are clinically justified and you can secure or appeal for the added authorization.

CARC 198 — FAQ

What does CARC 198 mean?

Services exceeded what the authorization allowed (units, visits, or scope). Seek additional authorization or appeal with clinical justification for the extra services.

How is CARC 198 different from 197?

197 means no authorization was present at all; 198 means an authorization existed but the billed services went beyond it.