Billing codes, explained clearly
Original guidance, traceable sources and visible review dates.
| Last reviewed | ||
|---|---|---|
| CARC 1: Deductible amount | The payer applied this amount to the patient's deductible, so the patient owes it instead of the plan. | 2026-10-05 |
| CARC 109: Not covered by this payer, send to the correct payer | This payer is not responsible for the claim. Another payer or contractor should get it. | 2026-10-05 |
| CARC 16: Claim lacks information or has billing errors | The claim is missing information or contains an error, so the payer could not process it. A remark code (RARC) on the remittance usually says exactly what is missing. | 2026-10-05 |
| CARC 18: Exact duplicate claim or service | The payer believes this claim or line was already submitted and processed. | 2026-10-05 |
| CARC 197: Prior authorization missing | The service needed prior authorization, precertification or notification, and the payer has none on file. | 2026-10-05 |
| CARC 2: Coinsurance amount | This is the patient's coinsurance share, a percentage of the allowed amount, which the patient owes. | 2026-10-05 |
| CARC 22: May be covered by another payer (coordination of benefits) | The payer thinks another plan should pay first. | 2026-10-05 |
| CARC 23: Impact of the prior payer's payment or adjustment | This adjustment reflects what the primary payer already paid or adjusted. | 2026-10-05 |
| CARC 26: Service before coverage started | The date of service is before the patient's coverage began. | 2026-10-05 |
| CARC 27: Service after coverage ended | The date of service is after the patient's coverage ended. | 2026-10-05 |
| CARC 29: Filing limit expired | The claim reached the payer after its timely filing deadline. | 2026-10-05 |
| CARC 3: Co-payment amount | This is the patient's fixed copay for the visit or service, which the patient owes. | 2026-10-05 |
| CARC 31: Patient cannot be identified as the payer's member | The payer could not match the patient to one of its members. | 2026-10-05 |
| CARC 4: Modifier missing or inconsistent with the procedure code | The procedure code needs a modifier that was missing, or the modifier sent does not fit that code. | 2026-10-05 |
| CARC 45: Charge exceeds the allowed amount | Your charge is higher than the payer's allowed amount under your contract or fee schedule. The difference is adjusted off. | 2026-10-05 |
| CARC 5: Procedure code or bill type does not match the place of service | The service code does not fit the place of service on the claim. | 2026-10-05 |
| CARC 50: Not medically necessary | The payer decided the service was not medically necessary based on the information sent. | 2026-10-05 |
| 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. | 2026-10-05 |
| CARC 96: Non-covered charge | The service is not covered under the patient's plan. A RARC usually explains why. | 2026-10-05 |
| CARC 97: Included in another service (bundled) | The payer considers this service part of another service paid on the same claim or day, so it is not paid separately. | 2026-10-05 |