CARC 6: Procedure inconsistent with the patient’s age
The payer's rules say this procedure or code does not fit the patient's age.
Group code context
Usually sent with group code CO (contractual obligation): under your contract you cannot bill the patient for this amount.
Common causes
- Wrong date of birth in the patient record
- Age-specific code (for example preventive visit codes) does not match the age
- Pediatric code used for an adult or the reverse
Step-by-step fix
- Check the date of birth against the insurance card and eligibility
- If the DOB was wrong, fix it and resubmit
- If the code was wrong, correct it and send a corrected claim
Appeal guidance
Appeal with the record if the code and age are correct and the payer edit is wrong.
When not to appeal
Do not appeal if the code does not fit the age. Correct it.
Prevention checklist
- Verify demographics at registration
- Use age-based scrubber edits for preventive codes
Related codes
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Source and review
Official source ↗Last checked: 2026-10-05
Reviewed by: PracticeVendors editorial team
Educational reference. Confirm payer instructions and applicable contracts before taking action.