What does denial code CARC 16 mean?

CARC 16 — Claim/service lacks information needed for adjudication. A required data element is missing or incomplete — rendering/billing NPI, diagnosis pointers, units, or a required modifier. The accompanying RARC tells you exactly which element. How to work it: Read the paired RARC to find the missing field, correct it, and submit a corrected claim. N290/N257 point to provider identifiers; M51 to a missing/invalid procedure code; MA27/N382 to subscriber/member ID issues.

What does denial code CARC 50 mean?

CARC 50 — These are non-covered services — not deemed a medical necessity. The diagnosis on the claim doesn't support medical necessity for the procedure under the payer's LCD/NCD policy. How to work it: Compare the billed ICD-10 against the payer LCD/NCD for that CPT. If the record supports a covered diagnosis, submit a corrected claim; otherwise appeal with documentation or route to patient responsibility via ABN.

What does denial code CARC 11 mean?

CARC 11 — The diagnosis is inconsistent with the procedure. The linked diagnosis doesn't clinically justify the procedure performed. How to work it: Re-check diagnosis-to-procedure linkage against the documentation, point each CPT to the diagnosis that supports it, and submit corrected.

What does denial code CARC 97 mean?

CARC 97 — Benefit is included in the payment for another service/procedure (bundled). The procedure is a component of another billed procedure — an NCCI PTP edit or a service inside the global period. How to work it: Run the NCCI PTP edit pair. If the column-2 service was truly separate and documented, append the appropriate modifier (59/XE/XS/XP/XU) and resubmit; otherwise the bundling is correct.

What does denial code CARC 4 mean?

CARC 4 — Procedure code is inconsistent with the modifier, or a required modifier is missing. A required modifier is absent, or a modifier conflicts with the procedure code. How to work it: Apply the correct modifier per NCCI/payer rules (25 for a separate E/M, 59/X{EPSU}, 26/TC, 50, 51, RT/LT), remove any conflicting modifier, and submit a corrected claim.

What does denial code CARC 18 mean?

CARC 18 — Exact duplicate claim/service. The same service/date/provider was already submitted, or repeated units were billed as separate lines. How to work it: Check claim history. If it is a true duplicate, no action. If it was a legitimately repeated service, bill correct units or append modifier 76/77/91 and resubmit.

What does denial code CARC 197 mean?

CARC 197 — Precertification / authorization / notification absent. The service required prior authorization that was not obtained or not attached. How to work it: Check for an auth on file. If one exists, submit a corrected claim with the authorization number. If not, request a retro-authorization where the payer allows it, then appeal.

What does denial code CARC 96 mean?

CARC 96 — Non-covered charge(s). The service is not a covered benefit under the patient's plan. How to work it: Verify the benefit. If covered, correct the coding/POS that triggered the denial and resubmit. If genuinely non-covered, bill the patient when an ABN/agreement is on file.

What does denial code CARC 151 mean?

CARC 151 — Payment adjusted — information does not support this many services. Units or frequency exceed the payer's allowed limit (MUE) for the code. How to work it: Compare billed units to the MUE for that CPT. If documentation supports the higher count, resubmit with the correct modifier and records; otherwise correct the units.

What does denial code CARC 109 mean?

CARC 109 — Claim not covered by this payer/contractor. The claim was sent to the wrong payer, or the COB primary/secondary order is wrong. How to work it: Verify the correct payer and coordination-of-benefits order, set the filing indicator and payer loop, and rebill to the right payer.

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Denial Code Lookup

Search the full set of 1298+ CARC and RARC denial codes by code or reason. Every code shows what it means and how to work and prevent it — the top denials add hand-written, denial-specific playbooks.

Educational reference.CARC/RARC handling varies by payer, plan, and contract. Use this as a starting point and confirm specifics in the payer's remittance guidance or your clearinghouse.

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