Denial codes
Denial codes: CARC and RARC meanings
164 claim adjustment reason codes and 57 remark codes, each with a plain-English meaning, common causes, and what to check before resubmitting.
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Group codes
- CO
- Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
- PR
- Patient responsibility. The patient, or a secondary payer, may owe the amount.
- OA
- Other adjustment. An adjustment that is neither the provider's nor the patient's, often from coordination of benefits.
- PI
- Payer initiated reduction. The payer reduced the amount on its own. The patient is not billed for it.
- CR
- Correction and reversal. Corrects or reverses an earlier claim adjustment.
Most searched reason codes
- 16Missing or wrong information on the claimCO-16
- 45Charge over the allowed amountCO-45
- 50Not medically necessaryCO-50
- 97Included in another serviceCO-97
- 197Authorization missingCO-197
- 29Timely filing limit passedCO-29
- 1DeductiblePR-1
- 18Exact duplicate claim or serviceCO-18
- 204Not covered by the current planCO-204
- 96Non-covered chargeCO-96
- 109Wrong payerCO-109
- 11Diagnosis does not support the procedureCO-11
- 4Modifier missing or does not fit the codeCO-4
- 2CoinsurancePR-2
- 22Another payer may be primaryCO-22
- 253SequestrationCO-253
- 27Service after coverage endedCO-27
- 3CopayPR-3
- 31Patient not found as a memberCO-31
- 146Diagnosis invalid for the date of serviceCO-146
- 226Requested information not sentCO-226
- 26Service before coverage startedCO-26
- 5Code does not fit the place of serviceCO-5
- 167Diagnosis not coveredCO-167
- 181Procedure code invalid on the date of serviceCO-181
- 252Attachment neededCO-252
- 49Routine or preventive service not coveredCO-49
- 119Benefit maximum for the period reachedCO-119
- 140Patient name and ID do not matchCO-140
- 151Number or frequency of services not supportedCO-151
- 236Procedure or modifier pair not compatibleCO-236
- 58Wrong place of serviceCO-58
- 185Rendering provider not eligibleCO-185
- 8Code does not fit the provider type or specialtyCO-8
- B7Provider not certified for this service on this dateCO-B7
- 150Level of service not supportedCO-150
- 198Authorization exceededCO-198
- 234Not paid separatelyCO-234
- 59Multiple or concurrent procedure reductionCO-59
- 6Code does not fit the patient's ageCO-6
Most searched remark codes
- N130Check the plan's benefit documents
- MA130Claim unprocessable, no appeal rights
- M15Bundled as parts of one procedure
- M51Procedure code missing or invalid
- M76Diagnosis missing or invalid
- MA18Sent on to the supplemental insurer
- M80Not covered on the same date as an earlier service
- MA04Primary payer information needed
- N115Decision based on a Local Coverage Determination
- N290Rendering provider ID missing or invalid
- M119NDC missing or invalid
- M77Place of service missing or wrong
- M86Same or similar service already paid in the period
- MA01Appeal rights notice
- N20Not paid with another service on the same date
- N265Ordering provider ID missing or invalid
- N30Patient not eligible for this service
- N362Units over the allowed maximum
- N386Decision based on a National Coverage Determination
- N479Primary payer's explanation of benefits missing
Full lists
Questions
What is a denial code?
On a remittance (835) or EOB, a claim adjustment reason code (CARC) says why a claim line was paid differently than billed. It comes with a group code, such as CO or PR, that says who owes the difference.
What does CO mean on a denial?
Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
What does PR mean on a denial?
Patient responsibility. The patient, or a secondary payer, may owe the amount.
What is a remark code?
A remittance advice remark code (RARC), such as N130 or M15, adds detail to the reason code. It often names the field to fix or the policy that applied.
Why is the exact X12 wording not on this site?
X12 owns the CARC and RARC lists and does not allow its descriptions to be republished. Each page here has a plain-English summary written by Rivvi and a link to the X12 list.