Claim adjustment reason code
Denial code CO-49 meaning
CARC 49, usually seen as CO-49: The service is a routine exam or screening, or was done with one, and the plan does not cover it.
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- Reason code
- CARC 49
- Short name
- Routine or preventive service not covered
- Plain meaning
- The service is a routine exam or screening, or was done with one, and the plan does not cover it.
- Group codes
- CO-49: Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
Plain-English summary written by Rivvi. X12 owns the CARC list and its exact wording, which is not reproduced here. Read it on the X12 CARC list (list dated November 1, 2025, checked October 23, 2026). This page does not decide how a claim is paid.
Common causes
- The plan excludes routine exams, or the screening frequency was not met.
- A diagnostic service was billed with routine diagnosis codes.
What to check before resubmitting
- Check the plan's preventive benefits and frequency limits.
- If the service was diagnostic, code the diagnosis that shows why.
Remark codes that often come with it
Related reason codes
Related pages
Questions
What does denial code CO-49 mean?
The service is a routine exam or screening, or was done with one, and the plan does not cover it. This is Rivvi's plain-English summary of CARC 49. X12's exact wording is on x12.org.
How do I fix CO-49?
Check the plan's preventive benefits and frequency limits. If the service was diagnostic, code the diagnosis that shows why.
Can I bill the patient for CO-49?
With group code CO, no. CO means the provider absorbs the amount under its contract or the payer's rules.
Which group codes come with CARC 49?
Most often CO (contractual obligation). The group code, not the reason code, says who owes the amount.
What is the difference between a CARC and a RARC?
A claim adjustment reason code (CARC) says why a claim line was paid differently than billed. A remittance advice remark code (RARC) adds detail, such as which field is missing.