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 |
|---|---|---|
| 65 | Incorrect From DOS Please resubmit with corrected From DOS on claim. | Details → |
| 66 | Blood Deductible. Start: 01/01/1995 | Details → |
| 66 | Denied. The admit and discharge dates are the same. Rebill this service as outpatient… | Details → |
| 66 | Incorrect To DOS Please resubmit with corrected TO DOS on claim. | Details → |
| 67 | Lifetime reserve days. (Handled in QTY, QTY01=LA) Start: 01/01/1995 | Stop: 10/16/20… | Details → |
| 67 | Adjusted. Examination completed within 6 weeks of a "no show" exam billed to L&I. | Details → |
| 67 | Incorrect Admit Type Please resubmit with a correct Admit Type on claim. | Details → |
| 68 | DRG weight. (Handled in CLP12) Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 68 | Incorrect HIPPS code Please resubmit with corrected HIPPS code on IRF claim. | Details → |
| 69 | Day outlier amount. Start: 01/01/1995 | Details → |
| 69 | Denied. The provider is not an approved chiropractic consultant with L&I. | Details → |
| 69 | Incorrect IRF charges Please resubmit with corrected charges on IRF claim | Details → |
| 70 | Cost outlier - Adjustment to compensate for additional costs. Start: 01/01/1995 | La… | Details → |
| 70 | Allowable fee set by L&I Chiropractic Consultant based upon review of report. | Details → |
| 70 | Incorrect Rev code/HCPC rate Please resubmit with corrected Revenue Code and HCPCS/Ra… | Details → |
| 71 | Primary Payer amount. Start: 01/01/1995 | Stop: 06/30/2000 Notes: Use code 23. | Details → |
| 71 | Denied. Injury occurred while in course of employment subject to Longshore & Harbor W… | Details → |
| 71 | Invalid claim line units Claim line units not equal to days reflected with span code … | Details → |
| 72 | Coinsurance day. (Handled in QTY, QTY01=CD) Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 72 | Denied. Rebill services under the performing provider's name and provider number and/… | Details → |
| 72 | Annual benefit amount exceeded Annual benefit amount exceeded | Details → |
| 73 | Administrative days. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 73 | Payment adjusted per review by Department Occupational Nurse Consultant. | Details → |
| 73 | Lifetime benefit amount exceeded Lifetime benefit amount exceeded | Details → |
| 74 | Indirect Medical Education Adjustment. Start: 01/01/1995 | Details → |
| 74 | Denied. Replacement and repair of this item is not covered by L&I. | Details → |
| 74 | Individual Lifetime visits exceeded Individual Lifetime visits exceeded | Details → |
| 75 | Direct Medical Education Adjustment. Start: 01/01/1995 | Details → |
| 75 | Denied. Requested records not rec'd by August(AHS). Injured worker is not to be bille… | Details → |
| 75 | Not covered This service is not a covered benefit under the plan for this date of ser… | Details → |
| 76 | Disproportionate Share Adjustment. Start: 01/01/1995 | Details → |
| 76 | Denied. Claim reopened for provisional time-loss only. If/when reopened for medical, … | Details → |
| 76 | Benefit visit limit exceeded Benefit visit limit exceeded | Details → |
| 77 | Covered days. (Handled in QTY, QTY01=CA) Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 77 | Procedure billed needs a referral ID on the bill. Contact the referring vocational pr… | Details → |
| 77 | Benefit dollar limit exceeded Benefit dollar limit exceeded | Details → |
| 78 | Non-Covered days/Room charge adjustment. Start: 01/01/1995 | Details → |
| 78 | Services paid. Claim now closed and no additional benefits are payable. | Details → |
| 78 | Excluded from provider contract This service is excluded from the Provider's contract… | Details → |
| 79 | Cost Report days. (Handled in MIA15) Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 79 | Denied. This is a rebill of an original that is currently under review by utilization… | Details → |
| 79 | Duplicate Mem/DOS/Service Code/Pay To/Modifier Duplicate Mem/DOS/Service Code/Pay To/… | Details → |
| 80 | Outlier days. (Handled in QTY, QTY01=OU) Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 80 | Anesthesia services reimbursed under RBRVS are not paid by base and time units. | Details → |
| 80 | Dup mem/DOS/Svc Code/ Pay To/Rend Phys/Mod Duplicate member/DOS/Service Code/ Pay To/… | Details → |
| 81 | Discharges. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 81 | Units adjusted to 24. This procedure's unit value is calculated on a per hour basis. | Details → |
| 81 | One 0024 revenue code is permitted per claim Per CMS guidelines, only one 0024 revenu… | Details → |
| 82 | PIP days. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 82 | The modifier used requires a report. No report has been received for these services. | Details → |
| 82 | Resubmit with appropriate diagnosis codes. Please resubmit the claim with appropriate… | Details → |
| 83 | Total visits. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 83 | When using a group number you must also indicate by provider number which doctor perf… | Details → |
| 83 | Duplicate claim line Duplicate claim line (same provider/member/DOS/CPT(REV) | Details → |
| 84 | Capital Adjustment. (Handled in MIA) Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 84 | Units or payment adjusted to pay maximum allowable amount per day. | Details → |
| 84 | Not covered/Not allowable by contract Service not covered/Not allowable by contract f… | Details → |
| 85 | Patient Interest Adjustment (Use Only Group code PR) Start: 01/01/1995 | Last Modifi… | Details → |
| 85 | Units per injury per time period exceeded. Denied/Adjusted per current fee schedule m… | Details → |
| 85 | Duplicate Claim (Provider/Member/DOS) Duplicate Claim (Provider/Member/DOS) | 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.