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 |
|---|---|---|
| P58 | When billing for procedure 99080 with E/M, a separate chart note and report are requi… | Details → |
| P59 | Denied. Activity Prescription Form was not requested by L&I. | Details → |
| P6 | Based on entitlement to benefits. Usage: If adjustment is at the Claim Level, the pay… | Details → |
| P60 | Denied. Date of service is after provider's date of death. | Details → |
| P61 | Denied. Radiology consultation service can only be performed by a provider with a spe… | Details → |
| P62 | Denied. Individual name of provider must be listed under appointment information on I… | Details → |
| P63 | Denied. Same day charges for same claim number must be on the same bill. Please submi… | Details → |
| P64 | Denied. Signed Interpreter Services Appointment Record (ISAR) has not been received f… | Details → |
| P65 | Lines were added to your bill to split your charges to match multiple referral dates. | Details → |
| P66 | Denied. Injection of anesthetic agent is bundled with the surgery procedure. | Details → |
| P67 | Adjudicated per instructions from provider review auditor. | Details → |
| P68 | Denied. Documentation to justify payment has either no time or not enough time noted … | Details → |
| P69 | Payment for this line item reduced. Time documented in note does not support units bi… | Details → |
| P7 | The applicable fee schedule/fee database does not contain the billed code. Please res… | Details → |
| P70 | Denied. No handwritten chart note/report received to support services billed. | Details → |
| P71 | Denied. Chart notes modified. Unable to determine what services were rendered and/or … | Details → |
| P72 | The tax identification number and name on your provider account does not match IRS re… | Details → |
| P73 | A request for payment outside of policy has been received and processed. | Details → |
| P74 | Denied. Tax ID number on your provider account does not match the tax ID number on yo… | Details → |
| P75 | Denied. Supporting documentation or provider signature is illegible. | Details → |
| P76 | Denied. Paid under wrong provider/payee number. | Details → |
| P77 | Denied. Report/documentation submitted does not justify payment for a surgical assist… | Details → |
| P78 | Denied per L&I Claims Consultant. | Details → |
| P79 | Denied. L&I does not issue provider numbers to this type of provider. See WAC 296-20-… | Details → |
| P8 | Claim is under investigation. Usage: If adjustment is at the Claim Level, the payer m… | Details → |
| P80 | Denied. Only one claim was requested on IME assignment. | Details → |
| P81 | Denied. Dispensing fee not payable when hearing aids have been denied. Please resubmi… | Details → |
| P82 | Denied. Tax ID number is missing. Resubmit new bill with tax ID number. | Details → |
| P83 | Bill with your current tax ID number on future billings. | Details → |
| P84 | All or part of service(s) performed was non-covered per L&I policy. | Details → |
| P85 | Payment for this line item is reduced. All or part of service is payable under a diff… | Details → |
| P86 | Payment denied as per the provider fraud program's prepayment review. | Details → |
| P87 | Payment reduced as per the provider fraud program's prepayment review. | Details → |
| P88 | Denied. A specific description of the item that was repaired must be in remarks or on… | Details → |
| P89 | Procedure 99080 paid as a 60 day report. | Details → |
| P9 | No available or correlating CPT/HCPCS code to describe this service. To be used for P… | Details → |
| P90 | Procedure 99080 paid as a response to insurer request. | Details → |
| P91 | These payments have been adjusted due to a change in the offset amount. | Details → |
| P92 | PT (97001-97799) not payable to naturopaths. Refer to WA State Fee Schedule to determ… | Details → |
| P98 | Payment made for Report of Accident (ROA) submitted via paper/fax. | Details → |
| P99 | Payment made for Report of Accident (ROA) submitted via web. | Details → |
| Q01 | Prior authorization (PA#) number has been cancelled. | Details → |
| Q02 | Denied. Only 1 PT/OT visit allowed per day; PT/OT visit billed by and paid to another… | Details → |
| Q03 | PT or OT services provided by more than one provider at same visit; PT or OT daily ca… | Details → |
| Q04 | PT or OT daily cap met; payment for this line item reduced. | Details → |
| Q05 | Denied. Performing provider signature missing from supporting documentation. Unable t… | Details → |
| Q06 | Per review by L&I therapy consultant. | Details → |
| Q07 | Paid. Diagnostic(s)and/or Service(s)requested by the IME Examiner/Panel or Department… | Details → |
| R01 | Denied. Provider letter mailed separately to explain this denial. | Details → |
| R02 | Denied. Injured worker letter mailed separately to explain this denial. | Details → |
| R03 | Denied. Prescription co-pay letter mailed separately to explain this denial. | Details → |
| R04 | Denied. Health care co-pay letter mailed separately to explain this denial. | Details → |
| R05 | Denied. Pharmacy letter mailed separately to explain this denial. | Details → |
| R06 | Denied. Provider compliance letter mailed separately to explain this denial. | Details → |
| R07 | Denied. Travel Reimbursement Request return letter mailed separately to explain this … | Details → |
| R08 | Denied. Drug reimbursement letter mailed separately to explain this denial. | Details → |
| R09 | Denied. Provider letter mailed separately to explain this denial. | Details → |
| R10 | Injured worker letter mailed separately to explain how your bill was processed. | Details → |
| R11 | Legal representation letter mailed separately to explain how your bill was processed. | Details → |
| R12 | Denied. The legal maximum of $12,000 for retraining has been expended. | 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.