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 |
|---|---|---|
| 26 | Vision This claim is the responsibility of Bravo Health's Delegated Vision Vendor. Th… | Details → |
| 27 | Expenses incurred after coverage terminated. Start: 01/01/1995 | Details → |
| 27 | Denied. Not authorized to provide work hardening services. Contact work hardening rev… | Details → |
| 27 | Health and Wellness This claim is the responsibility of Bravo Health's Delegated Heal… | Details → |
| 28 | Coverage not in effect at the time the service was provided. Start: 01/01/1995 | Sto… | Details → |
| 28 | A maximum of 1 service unit is allowed. | Details → |
| 28 | Dental This claim is the responsibility of Bravo Health's Delegated Dental Vendor. Th… | Details → |
| 29 | The time limit for filing has expired. Start: 01/01/1995 | Details → |
| 29 | Denied. Home nursing travel, holidays, overtime & weekends are considered the provide… | Details → |
| 29 | The time limit for filing has expired. You may not appeal this decision. | Details → |
| 29 | Adjusted claim This is an adjusted claim. | Details → |
| 30 | Payment adjusted because the patient has not met the required eligibility, spend down… | Details → |
| 30 | A maximum of 300 miles is allowed. | Details → |
| 30 | Auth match The services billed do not match the services that were authorized on file… | Details → |
| 31 | Patient cannot be identified as our insured. Start: 01/01/1995 | Last Modified: 09/3… | Details → |
| 31 | This was paid at the highest allowable fee for breakfast, lunch or dinner. | Details → |
| 31 | Patient cannot be identified as our insured. | Details → |
| 31 | Not covered Medicare This service is not covered by Medicare. | Details → |
| 32 | Our records indicate the patient is not an eligible dependent. Start: 01/01/1995 | L… | Details → |
| 32 | Denied. The tooth number billed has not been authorized. | Details → |
| 32 | Not covered benefit This service is not a covered benefit for this plan however the p… | Details → |
| 33 | Insured has no dependent coverage. Start: 01/01/1995 | Last Modified: 09/30/2007 | Details → |
| 33 | Lack of correct amount of units on bill can reduce or delay payment. | Details → |
| 33 | POS Please resubmit this claim with the correct place of service. | Details → |
| 34 | Insured has no coverage for newborns. Start: 01/01/1995 | Last Modified: 09/30/2007 | Details → |
| 34 | Number of hours paid per agreement with L&I Occupational Nurse Consultant. | Details → |
| 35 | Lifetime benefit maximum has been reached. Start: 01/01/1995 | Last Modified: 10/31/… | Details → |
| 35 | Paid professional component only. Technical component billed by and paid to another p… | Details → |
| 35 | Maximum rental months have been paid for item | Details → |
| 35 | Per Diem Services included in Per Diem | Details → |
| 36 | Balance does not exceed co-payment amount. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 36 | Adjustment/deduction taken to credit base anesthesia units that were billed by you in… | Details → |
| 36 | Facility Services included in facility fee | Details → |
| 37 | Balance does not exceed deductible. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 37 | L&I responsible for payment of this bill. Reimburse payments made by other sources. | Details → |
| 37 | RUGS Services included in RUGS rate | Details → |
| 38 | Services not provided or authorized by designated (network/primary care) providers. … | Details → |
| 38 | Use modifier -7N with X-ray, lab services, and other allowed diagnostic services perf… | Details → |
| 38 | Visit Services included in visit rate | Details → |
| 39 | Services denied at the time authorization/pre-certification was requested. Start: 01… | Details → |
| 39 | Denied. The legal maximum of $4000 for retraining has been expended. | Details → |
| 39 | Invalid revenue code Claim has been submitted with an invalid revenue code. Please re… | Details → |
| 40 | Charges do not meet qualifications for emergent/urgent care. Usage: Refer to the 835 … | Details → |
| 40 | Denied. Place of service is invalid/invalid for date of service. Resubmit with valid … | Details → |
| 40 | Invalid modifier The modifier submitted on this claim is invalid for the date of serv… | Details → |
| 41 | Discount agreed to in Preferred Provider contract. Start: 01/01/1995 | Stop: 10/16/2… | Details → |
| 41 | Adjustment made to this bill per contractual agreement with utilitzation review (UR) … | Details → |
| 41 | Invalid procedure code The procedure code billed is not valid. Please resubmit this c… | Details → |
| 42 | Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45) Start: 01… | Details → |
| 42 | Payment of this service has been made per Board of Industrial Insurance Appeals (BIIA… | Details → |
| 42 | Invalid ICD9 code Please resubmit this claim with a valid ICD9 diagnosis code. | Details → |
| 43 | Gramm-Rudman reduction. Start: 01/01/1995 | Stop: 07/01/2006 | Details → |
| 43 | Denied. Procedure code missing from bill. | Details → |
| 43 | Par filing deadline exceeded All claims for participating providers must be submitted… | Details → |
| 44 | Prompt-pay discount. Start: 01/01/1995 | Details → |
| 44 | Denied. Out of state travel expenses incurred prior to 7-1-91 are not payable. | Details → |
| 44 | No detail Please resubmit this claim with a detailed bill showing the charges and spe… | Details → |
| 45 | Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangemen… | Details → |
| 45 | Denied. Type service/procedure code is invalid. Refer to current fee schedule for val… | Details → |
| 45 | Payment was made for this claim conditionally because an HHA episode of care has been… | 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.