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 |
|---|---|---|
| 45 | No EOB Please resubmit with EOB in order to complete processing of the claim. | Details → |
| 46 | This (these) service(s) is (are) not covered. Start: 01/01/1995 | Stop: 10/16/2003 … | Details → |
| 46 | Payment made to correct your account for the refund which you made to L&I. | Details → |
| 46 | No occurrence code Please resubmit with corrected Occurrence Code on claim | Details → |
| 47 | This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Start: 01/… | Details → |
| 47 | Denied. Treatment is available within ten miles, one way. Travel expense is not payab… | Details → |
| 47 | Correct occurrence span Please resubmit with corrected Occurrence Code Span on claim. | Details → |
| 48 | This (these) procedure(s) is (are) not covered. Start: 01/01/1995 | Stop: 10/16/2003… | Details → |
| 48 | Adjudicated per instructions from Claim Manager. | Details → |
| 48 | Correct condition code Please resubmit with corrected Condition Code on claim. | Details → |
| 49 | This is a non-covered service because it is a routine/preventive exam or a diagnostic… | Details → |
| 49 | Denied. No Report of Accident (ROA) has been received for this claim number by L&I. | Details → |
| 49 | Duplicate Claim Line (Same Member/DOS/CPT(REV) Duplicate Claim Line (Same Member/DOS/… | Details → |
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by th… | Details → |
| 50 | Only 1 new patient visit allowed within 3 years. | Details → |
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by th… | Details → |
| 50 | Duplicate Mem/DOS/Pay To/Rendering Phys/Charges Duplicate Mem/DOS/Pay To/Rendering Ph… | Details → |
| 51 | These are non-covered services because this is a pre-existing condition. Usage: Refer… | Details → |
| 51 | Payment made to EBP for review of service for which claim was not received/initiated … | Details → |
| 51 | Invalid claim data found on IRF claim. Invalid claim data found on IRF claim. | Details → |
| 52 | The referring/prescribing/rendering provider is not eligible to refer/prescribe/order… | Details → |
| 52 | Denied. The maximum allowable number of units was paid on another line or bill. | Details → |
| 52 | Benefit Requires Contracted (PAR) provider. Benefit Requires Contracted (PAR) provide… | Details → |
| 53 | Services by an immediate relative or a member of the same household are not covered. … | Details → |
| 53 | Services 9/98 through 6/99, 40 maximum units allowed. Services 7/99 on, 32 maximum un… | Details → |
| 53 | Benefit requires non-contracted (NONPAR) provider. Benefit requires non-contracted (N… | Details → |
| 54 | Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 … | Details → |
| 54 | Denied. Clinic provider number may not be used in provider field, only payee field. | Details → |
| 54 | Service not within the scope of your contract. Service provided is not included withi… | Details → |
| 55 | Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: … | Details → |
| 55 | Payment adjusted or denied. Only one unit of service payable per claim. | Details → |
| 55 | Incorrect value code Please resubmit with corrected Value Code on claim | Details → |
| 56 | Procedure/treatment has not been deemed 'proven to be effective' by the payer. Usage:… | Details → |
| 56 | Denied. Chart notes are required for services billed. No additional amount is payable… | Details → |
| 56 | Incorrect admission date Please resubmit with corrected Admission Date on claim | Details → |
| 57 | Payment denied/reduced because the payer deems the information submitted does not sup… | Details → |
| 57 | Submit charges for rehab DRG 462 under your facilities separate rehab unit provider n… | Details → |
| 57 | Discharge status required Discharge status is required for inpatient and SNF claims. | Details → |
| 58 | Treatment was deemed by the payer to have been rendered in an inappropriate or invali… | Details → |
| 58 | Denied. E/M code not payable with MPE or impairment rating by same provider/claim/dat… | Details → |
| 58 | Admission source required Admission source required | Details → |
| 59 | Processed based on multiple or concurrent procedure rules. (For example multiple surg… | Details → |
| 59 | Payment adjusted to number of service units authorized by the Claim Manager. | Details → |
| 59 | Incorrect patient status Please resubmit with corrected patient status for bill type … | Details → |
| 60 | Charges for outpatient services are not covered when performed within a period of tim… | Details → |
| 60 | Denied. Please rebill using the correct provider number for these services. | Details → |
| 61 | Adjusted for failure to obtain second surgical opinion Start: 01/01/1995 | Last Modi… | Details → |
| 61 | Allowed at combined procedure code rate per L&I published fee schedule. | Details → |
| 61 | HIPPS RUGS DOS billed dollars HH PPS and RUGS DOS billed amount should not have a dol… | Details → |
| 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. … | Details → |
| 62 | Fee for visit includes care of the day.COM15 | Details → |
| 62 | HIPPS RUG requires rehab HIPPS RUG rate code requires rehabilitation therapy | Details → |
| 63 | Correction to a prior claim. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 63 | Denied. Reopening application is payable only on claims closed over 60 days. | Details → |
| 63 | Submit EOB Please resubmit with a EOB in order to complete the processing of the clai… | Details → |
| 64 | Denial reversed per Medical Review. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 64 | Denied. Fee for service includes office call. | Details → |
| 64 | Duplicate service code Duplicate service code on same claim with no modifier. Please … | Details → |
| 65 | Procedure code was incorrect. This payment reflects the correct code. Start: 01/01/1… | Details → |
| 65 | Only one adjustment form should be submitted listing all changes requested to an ICN … | 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.