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 |
|---|---|---|
| 202 | Charges must be submitted on a CMS-1500 for processing. | Details → |
| 203 | 3 Units Blood The first three units of blood are not covered services under this plan… | Details → |
| 203 | Discontinued or reduced service. Start: 02/28/2007 | Last Modified: 09/30/2007 | Details → |
| 203 | Charges adjusted according to your state's fee schedule. | Details → |
| 204 | UR Denied Days UR DENIED HOSPITAL DAYS | Details → |
| 204 | This service/equipment/drug is not covered under the patient's current benefit plan … | Details → |
| 204 | Denied. Primary and/or secondary diagnoses not accepted as related to this injury. | Details → |
| 204 | Noncovered item Item is not medically necessary for DME | Details → |
| 205 | After Death This date of service is after the date of the patient's death. | Details → |
| 205 | Pharmacy discount card processing fee Start: 07/09/2007 | Details → |
| 205 | Denied. Bills for crime victim claims must be submitted to the Crime Victim Compensat… | Details → |
| 206 | DRG Invalid The DRG submitted on this claim is not valid for the fiscal year billed. … | Details → |
| 206 | National Provider Identifier - missing. Start: 07/09/2007 | Last Modified: 09/30/200… | Details → |
| 206 | Denied. We have no record of a claim having been filed with L&I with this claim numbe… | Details → |
| 207 | ER in 72 hrs Emergency Room visits within 72 hours of an inpatient admission cannot b… | Details → |
| 207 | National Provider identifier - Invalid format Start: 07/09/2007 | Last Modified: 06/… | Details → |
| 207 | Denied. Each provider must bill charges separately. | Details → |
| 208 | Inc in case This service is included in the Case Rate | Details → |
| 208 | National Provider Identifier - Not matched. Start: 07/09/2007 | Last Modified: 09/30… | Details → |
| 208 | Please note the prescribing physician's new provider number and use it on future bill… | Details → |
| 209 | Inc in CMG Reimbursement for this service in included in the CMG | Details → |
| 209 | Per regulatory or other agreement. The provider cannot collect this amount from the p… | Details → |
| 209 | This provider is not authorized to provide this service. | Details → |
| 210 | Denied Days These hospital days have been denied by our Health Services Department. | Details → |
| 210 | Payment adjusted because pre-certification/authorization not received in a timely fas… | Details → |
| 210 | This transaction is a transfer of the credit portion of the interim payment. | Details → |
| 211 | Spec Dx Payment for this benefit requires specific diagnosis codes per CMS guidelines… | Details → |
| 211 | National Drug Codes (NDC) not eligible for rebate, are not covered. Start: 07/09/200… | Details → |
| 211 | Injured worker paid at L&I rate. Please reimburse the provider for this service. | Details → |
| 212 | Dup This is a duplicate of a claim that was previously adjudicated. | Details → |
| 212 | Administrative surcharges are not covered Start: 11/05/2007 | Details → |
| 212 | Denied. This is a self-insured claim number. | Details → |
| 213 | Location Service Facility Location Required. | Details → |
| 213 | Non-compliance with the physician self referral prohibition legislation or payer poli… | Details → |
| 213 | Inpatient bill adjusted to augment DRG database. | Details → |
| 214 | Adjust for Cap This claim is an adjustment for services capitated incorrectly accordi… | Details → |
| 214 | Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for… | Details → |
| 214 | Denied. The CPT procedure code submitted is not a valid code from the outpatient fee … | Details → |
| 215 | BT 710 Payment for claims submitted using bill type 710 will be $0.00 as this is a no… | Details → |
| 215 | Based on subrogation of a third party settlement Start: 01/27/2008 | Details → |
| 215 | Submit w/valid revenue code or if service is for lab, radiology, or PT use CPT proced… | Details → |
| 216 | Excl Excluded Service Not Covered | Details → |
| 216 | Based on the findings of a review organization Start: 01/27/2008 | Details → |
| 216 | NDC invalid for service date billed. | Details → |
| 217 | NotMember2 Denied: No coverage effective at time of service. | Details → |
| 217 | Based on payer reasonable and customary fees. No maximum allowable defined by legisla… | Details → |
| 217 | The revenue code was missing from the bill. | Details → |
| 218 | Based on entitlement to benefits. Note: If adjustment is at the Claim Level, the paye… | Details → |
| 218 | Interest penalty as a result of overpayment. | Details → |
| 219 | Based on extent of injury. Usage: If adjustment is at the Claim Level, the payer must… | Details → |
| 219 | Denied. This procedure is considered nonstandard and is not payable by L&I. | Details → |
| 220 | Qual Physician Quality Reporting Indicator codes are for reporting purposes only and … | Details → |
| 220 | The applicable fee schedule/fee database does not contain the billed code. Please res… | Details → |
| 220 | Denied. Bill not submitted in a timely manner patient is not responsible for this cha… | Details → |
| 221 | Item Bill Itemized Bill Request: Itemized bills can be faxed to 1(877)-788-2764 | Details → |
| 221 | Claim is under investigation. Note: If adjustment is at the Claim Level, the payer mu… | Details → |
| 221 | Denied. Only 1office call per day is permitted after the first 3 days of treatment. | Details → |
| 222 | Exceeds the contracted maximum number of hours/days/units by this provider for this p… | Details → |
| 222 | Denied. Effective January 1, 1987, $.36 tape billing fee is no longer payable by L&I. | Details → |
| 223 | ASC INCLUDED IN ASC RATE | 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.