CARC 96: Non-covered charge
The service is not covered under the patient's plan. A RARC usually explains why.
Group code context
Can come with group code PR (patient may owe it) or CO (you may not bill the patient). The group code decides who pays.
Common causes
- Service excluded by the plan, such as cosmetic services
- Benefit limit reached
- Service not covered for this diagnosis
Step-by-step fix
- Read the group code and RARC
- If PR, bill the patient as allowed
- If CO, check whether a valid waiver was signed
- If the code was wrong, correct it
Appeal guidance
Appeal only if the plan does cover the service and the denial is a processing error.
When not to appeal
Do not appeal real plan exclusions.
Prevention checklist
- Check benefits for services that are often excluded
- Have patients sign financial responsibility forms before non-covered services
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.