Claim adjustment reason code
Denial code CO-96 meaning
CARC 96, usually seen as CO-96: The plan does not cover this service. The payer adds a remark code with the reason.
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- Reason code
- CARC 96
- Short name
- Non-covered charge
- Plain meaning
- The plan does not cover this service. The payer adds a remark code with the reason.
- Group codes
- CO-96: Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it. PR-96: Patient responsibility. The patient, or a secondary payer, may owe the amount.
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 service is excluded from the plan.
- The service is covered only under conditions that were not met.
What to check before resubmitting
- Read the remark code on the line.
- With PR, the patient may owe it. With CO, the provider writes it off.
- For Medicare, bill the patient only with a valid ABN (modifier GA).
Remark codes that often come with it
Related reason codes
Related pages
Questions
What does denial code CO-96 mean?
The plan does not cover this service. The payer adds a remark code with the reason. This is Rivvi's plain-English summary of CARC 96. X12's exact wording is on x12.org.
How do I fix CO-96?
Read the remark code on the line. With PR, the patient may owe it. With CO, the provider writes it off. For Medicare, bill the patient only with a valid ABN (modifier GA).
Can I bill the patient for CO-96?
When it comes with group code PR, the patient or a secondary payer may owe the amount. When it comes with CO, the provider writes it off.
Which group codes come with CARC 96?
Most often CO (contractual obligation) or PR (patient responsibility). 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.