Instantly find explanations, causes, and resolution steps for every Claim Adjustment Reason Code (CARC) and Remark Code.
Claim Adjustment Reason Codes (CARC) explain why a payment differs from what was billed. Every 835 ERA and EOB uses these standardized codes.
Search any code or keyword above. Each page includes the full description, common causes, resolution steps, and appeal guidance.
Each denial code page also links to a dedicated Remark Code page — optimized for providers searching for ERA remark code context.
Most denials are reversible. Our guides walk you through the correct steps to correct, resubmit, or formally appeal each denial type.
| Code | Description | View |
|---|---|---|
| B43 | The 2nd proc code modifier is not a valid pymt modifier in conjunction with the proce… | Details → |
| B44 | The 3rd procedure code modifier is not a valid payment modifier in conjunction with t… | Details → |
| B45 | The 4th procedure code modifier is not a valid payment modifier in conjunction with t… | Details → |
| B46 | The 2nd procedure code modifier is invalid for this provider type. | Details → |
| B47 | The 3rd procedure code modifier is invalid for this provider type. | Details → |
| B48 | The 4th procedure code modifier is invalid for this provider type. | Details → |
| B49 | Bill returned to provider with information to establish a L&I provider number. | Details → |
| B5 | Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 | Last … | Details → |
| B50 | Denied, chart note amended incorrectly. Please refer to the Medical Aid Rules and Fee… | Details → |
| B6 | This payment is adjusted when performed/billed by this type of provider, by this type… | Details → |
| B62 | L&I cannot pay for retraining services 3 or more months in advance. Rebill closer to … | Details → |
| B63 | Denied. No record that an IME was requested/scheduled for the service date billed. | Details → |
| B64 | Multiple MRI's for the same part of body are not payable for the same date of service… | Details → |
| B66 | Denied. this is a Federal claim. Please contact the Department of Labor. | Details → |
| B67 | Denied. Service not billed in accordance with L&I policies and/or CPT guidelines. | Details → |
| B68 | This is an adjustment to correct diagnosis code mapping errors on inpatient bills tha… | Details → |
| B69 | Activity Prescription Form (APF) not received. | Details → |
| B7 | This provider was not certified/eligible to be paid for this procedure/service on thi… | Details → |
| B70 | Denied. Provider portion of the Report of Accident (ROA) has not been received. | Details → |
| B71 | Denied. Procedure/Diagnosis has been suspended. Please contact the Claim Manager. | Details → |
| B72 | Paid. Authorized per Pension Adjudicator/Treatment Order. | Details → |
| B73 | Denied. Signature and/or date are missing from submitted document. | Details → |
| B74 | Reduced. Some charges are included in the dispensing fee or are a non-covered item. | Details → |
| B75 | Denied. Please send your itemized list of charges as required by WAC-296-23A-150 and … | Details → |
| B76 | Service Qualifies for interest payment per RCW 51.36.080 | Details → |
| B77 | Interest paid per RCW 51.36.080 | Details → |
| B8 | Alternative services were available, and should have been utilized. Usage: Refer to t… | Details → |
| B9 | Patient is enrolled in a hospice program. | Details → |
| B9 | Patient is enrolled in a Hospice. Start: 01/01/1995 | Last Modified: 09/30/2007 | Details → |
| D01 | High dose alert. Drug dispensed exceeds maximum daily dosage. | Details → |
| D02 | Drug to drug interaction; severity level 1. Drug interacts with another drug dispense… | Details → |
| D03 | Two or more drugs have been prescribed/dispensed which may represent a duplicate ther… | Details → |
| D04 | Denied. Multiple DUR and/or refill-too-soon edits prevent payment. For information ca… | Details → |
| D05 | Non-preferred drug prescribed and therapeutic class has not been authorized for this … | Details → |
| D06 | Non-preferred drug prescribed by endorser without dispensed as written (DAW) indicato… | Details → |
| D07 | Submitted dispensed as written (DAW) is invalid. | Details → |
| D08 | The prescribing provider number entered does not have prescriptive authority. | Details → |
| D09 | Drug enforcement agency (DEA) number is not valid, it does not meet DEA number valida… | Details → |
| D1 | Claim/service denied. Level of subluxation is missing or inadequate. Start: 01/01/19… | Details → |
| D10 | Claim/service denied. Completed physician financial relationship form not on file. S… | Details → |
| D10 | Reimbursement includes the incentive fee for the acceptance of risk (prior authorizat… | Details → |
| D11 | Claim lacks completed pacemaker registration form. Start: 01/01/1995 | Stop: 10/16/2… | Details → |
| D11 | Missing/Invalid prior authorization type. | Details → |
| D12 | Claim/service denied. Claim does not identify who performed the purchased diagnostic … | Details → |
| D12 | Missing/Invalid prior authorization number. | Details → |
| D13 | Claim/service denied. Performed by a facility/supplier in which the ordering/referrin… | Details → |
| D13 | Prior authorization denied. Claim is on file, does not meet requirement allowing prio… | Details → |
| D14 | Claim lacks indication that plan of treatment is on file. Start: 01/01/1995 | Stop: … | Details → |
| D14 | Prior authorization for incentive fee was submitted but no allowed. The incentive fee… | Details → |
| D15 | Claim lacks indication that service was supervised or evaluated by a physician. Star… | Details → |
| D15 | Denied. Third Party supplemental agreement not on file. | Details → |
| D16 | Claim lacks prior payer payment information. Start: 01/01/1995 | Stop: 06/30/2007 N… | Details → |
| D16 | Denied. Third Party billers must submit all bills through L&I point-of-sale (POS) sys… | Details → |
| D17 | Claim/Service has invalid non-covered days. Start: 01/01/1995 | Stop: 06/30/2007 No… | Details → |
| D17 | Denied. This drug class requires prior authorization for use beyond 30 days. For auth… | Details → |
| D18 | Claim/Service has missing diagnosis information. Start: 01/01/1995 | Stop: 06/30/200… | Details → |
| D18 | Initial prescription qualifies for first fill payment. | Details → |
| D19 | Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/… | Details → |
| D19 | Prior authorization denied. Does not meet first fill requirements for payment of init… | Details → |
| D2 | Claim lacks the name, strength, or dosage of the drug furnished. Start: 01/01/1995 |… | Details → |
Medical claim denial codes — formally known as Claim Adjustment Reason Codes (CARC) — are standardized identifiers maintained by the X12 standards body and used across all Medicare, Medicaid, and commercial payer 835 electronic remittance transactions. When a claim is paid at a different amount than billed, at least one CARC code must accompany the remittance advice to indicate the specific reason for the adjustment.
The most frequently encountered codes include CO-16 (missing or invalid claim information), CO-45 (charges exceeding fee schedule), PR-1 (patient deductible), CO-29 (timely filing deadline exceeded), and CO-4 (procedure code inconsistent with modifier). Each represents a distinct, actionable reason that has a defined resolution pathway.