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 |
|---|---|---|
| 86 | No RAP A Request for Anticipated Payment (RAP) has not yet been submitted for this ep… | Details → |
| 86 | Statutory Adjustment. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Duplicative of co… | Details → |
| 86 | Payment adjusted. Payment of guest convenience items are the injured worker's respons… | Details → |
| 87 | Unmatched HIPPS The HIPPS code that was submitted on the RAP for this episode does no… | Details → |
| 87 | Transfer amount. Start: 01/01/1995 | Last Modified: 09/20/2009 | Stop: 01/01/2012 | Details → |
| 87 | Units adjusted to correct amount. Only 2 additional visits allowed per day. | Details → |
| 88 | No RAP 2 A Request for Anticipated Payment (RAP) has not yet been submitted for this … | Details → |
| 88 | Adjustment amount represents collection against receivable created in prior overpayme… | Details → |
| 88 | Referring provider number is missing/not valid for this claim. Contact referring voca… | Details → |
| 89 | Invalid from date The From statement date must equal the date on the service line ite… | Details → |
| 89 | Professional fees removed from charges. Start: 01/01/1995 | Details → |
| 89 | Denied. Service dates not within authorized dates for billed referral ID. | Details → |
| 90 | The statement From date is a required field. The statement From date is a required fi… | Details → |
| 90 | Ingredient cost adjustment. Usage: To be used for pharmaceuticals only. Start: 01/01… | Details → |
| 90 | Denied. Travel only reimbursed for scheduled treatment, exams and vocational services… | Details → |
| 91 | Duplicate RAP A Request for Anticipated Payment (RAP) has already been submitted for … | Details → |
| 91 | Dispensing fee adjustment. Start: 01/01/1995 | Details → |
| 91 | Bill's referral ID does not match claim number on bill, is missing or invalid. Correc… | Details → |
| 92 | RAP date discrepancy The statement From and Through date on the Request for Anticipat… | Details → |
| 92 | Claim Paid in full. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 92 | Denied. Performing provider number not valid for this date of service. | Details → |
| 93 | Include rev and HCPC codes for each service. Please resubmit the claim and include bo… | Details → |
| 93 | No Claim level Adjustments. Start: 01/01/1995 | Stop: 10/16/2003 Notes: As of 00401… | Details → |
| 93 | This bill was adjusted in error in 12-90 when the Dept processed accommodation code a… | Details → |
| 94 | HIPPS RUGS DOS not in time period. HIPPS RUGS Date of Service is not within the asses… | Details → |
| 94 | Processed in Excess of charges. Start: 01/01/1995 | Details → |
| 94 | Adjustment made to this bill per contractual agreement with utilization review (UR) v… | Details → |
| 95 | Not a member Denied: No coverage effective at time of service. | Details → |
| 95 | Plan procedures not followed. Start: 01/01/1995 | Last Modified: 09/30/2007 | Details → |
| 95 | Payment made to utilization review (UR) vendor for review of service for which claim … | Details → |
| 96 | Need EOB Please resubmit with an Explanation of Benefits from the primary insurance c… | Details → |
| 96 | Non-covered charge(s). At least one Remark Code must be provided (may be comprised of… | Details → |
| 96 | Denied. Requested records not received by utilization review (UR) vendor. Injured wor… | Details → |
| 96 | Beneficiary was inpatient on date of service billed | Details → |
| 97 | Incorrect bill type Please resubmit this claim with a corrected bill type | Details → |
| 97 | The benefit for this service is included in the payment/allowance for another service… | Details → |
| 97 | Denied. This is a rebill of an original that is currently under review by utilization… | Details → |
| 97 | Beneficiary was inpatient on date of service billed | Details → |
| 98 | Incorrect number of units Please resubmit with the correct number of units on claim. | Details → |
| 98 | The hospital must file the Medicare claim for this inpatient non-physician service. … | Details → |
| 98 | Denied. Incorrect procedure code for referral ID/type billed. | Details → |
| 99 | Inpatient hospital days have been exhausted. Inpatient hospital days have been exhaus… | Details → |
| 99 | Medicare Secondary Payer Adjustment Amount. Start: 01/01/1995 | Stop: 10/16/2003 | Details → |
| 99 | Charge/fee converted to rate of exchange in effect for date of service. | Details → |
| 100 | Rebundled Two or more procedure codes were rebundled into one comprehensive code. | Details → |
| 100 | Payment made to patient/insured/responsible party. Start: 01/01/1995 | Last Modified… | Details → |
| 100 | Effective 9/1/93 L&I will not pay for Stadol Nasal Solution. | Details → |
| 101 | Pre-op included Pre-Operative services are included in the surgical package. | Details → |
| 101 | Predetermination: anticipated payment upon completion of services or claim adjudicati… | Details → |
| 101 | Denied as duplicate. If not a duplicate, submit an adjustment request with documentat… | Details → |
| 102 | Post-op included Post-Operative services are included in the surgical package. | Details → |
| 102 | Major Medical Adjustment. Start: 01/01/1995 | Details → |
| 102 | Deny. No vocational rehabilitation counselor (VRC) is assigned to this referral. | Details → |
| 103 | Medical visit is not separately reimbursable. Medical visit is not separately reimbur… | Details → |
| 103 | Provider promotional discount (e.g., Senior citizen discount). Start: 01/01/1995 | L… | Details → |
| 103 | Deny. Payee provider is not assigned to this referral ID. | Details → |
| 104 | One initial/3 years Initial visit is only billed once per patient/provider every thre… | Details → |
| 104 | Managed care withholding. Start: 01/01/1995 | Details → |
| 104 | Denied. Service is included in flat fee or follow up care period for major surgery pe… | Details → |
| 105 | Duplicate claim. Duplicate claim. | 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.