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 |
|---|---|---|
| 223 | Adjustment code for mandated federal, state or local law/regulation that is not alrea… | Details → |
| 223 | This credit is taken due to a warrant cancellation. | Details → |
| 224 | CG CLAIMSGUARD ADJUSTMENT | Details → |
| 224 | Patient identification compromised by identity theft. Identity verification required … | Details → |
| 224 | The 1st procedure code modifier is not a valid payment modifier in conjunction with t… | Details → |
| 225 | Inc Included in other procedure. | Details → |
| 225 | Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting … | Details → |
| 225 | Denied. The noncovered line item charge exceeds the line item billed charge. | Details → |
| 226 | Dup Duplicate Line on Same Claim | Details → |
| 226 | Information requested from the Billing/Rendering Provider was not provided or not pro… | Details → |
| 226 | Denied. Bill type invalid for this provider type. Correct bill type/provider number &… | Details → |
| 227 | IncPay Service included in payment for surgical procedure. | Details → |
| 227 | Information requested from the patient/insured/responsible party was not provided or … | Details → |
| 227 | Paid as one hour. Supply time span for psychiatric exam in remarks on future bills. | Details → |
| 228 | NoCov Denied: No coverage effective at time of service. | Details → |
| 228 | Denied for failure of this provider, another provider or the subscriber to supply req… | Details → |
| 228 | Adjusted. On future bills indicate in remarks if psychiatrist was panel member and nu… | Details → |
| 229 | Partial charge amount not considered by Medicare due to the initial claim Type of Bil… | Details → |
| 229 | When billing unlisted procedure code, specific description of service must be in rema… | Details → |
| 230 | PHP The required Bravo Personal Health Profile Form was not received or was incomplet… | Details → |
| 230 | No available or correlating CPT/HCPCS code to describe this service. Note: Used only … | Details → |
| 230 | This item must be billed by NDC on the Statement for Pharmacy Services bill form. | Details → |
| 231 | Cap This is a capitated service | Details → |
| 231 | Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to… | Details → |
| 231 | When billing -22 modifier, you must explain the nature of the additional services in … | Details → |
| 232 | Therapy Please resubmit with the appropriate code to reflect the correct amount of th… | Details → |
| 232 | Institutional Transfer Amount. Usage: Applies to institutional claims only and explai… | Details → |
| 232 | You must list all applicable modifiers in remarks when billing modifier -99. | Details → |
| 233 | Insuf Svc Insufficient services on a day of a partial hospitalization. | Details → |
| 233 | Services/charges related to the treatment of a hospital-acquired condition or prevent… | Details → |
| 233 | The diagnosis supplied on your bill has been denied under this claim number. | Details → |
| 234 | This procedure is not paid separately. At least one Remark Code must be provided (may… | Details → |
| 234 | Paid at non-Washington percent of allowed charge (POAC) per WAC 296-23A-0230. | Details → |
| 234 | Item billed is included in allowance of other service provided on the same date | Details → |
| 235 | Sales Tax Start: 06/06/2010 | Details → |
| 235 | Denied. Primary and/or secondary diagnosis has been denied under this claim number. | Details → |
| 236 | This procedure or procedure/modifier combination is not compatible with another proce… | Details → |
| 236 | Bill remarks do not pertain to bill payment and have delayed processing. | Details → |
| 237 | Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comp… | Details → |
| 237 | Remarks do not justify -22 modifier. Submit paper adjustment with justification. | Details → |
| 238 | Claim spans eligible and ineligible periods of coverage, this is the reduction for th… | Details → |
| 238 | Inpatient admission not medically necessary per L&I Medical Consultant. Paid at 50%. | Details → |
| 239 | Claim spans eligible and ineligible periods of coverage. Rebill separate claims. Sta… | Details → |
| 239 | Prior authorization not obtained for inpatient admission. Paid at half of allowable f… | Details → |
| 240 | The diagnosis is inconsistent with the patient's birth weight. Usage: Refer to the 83… | Details → |
| 240 | Time lost from work is payable only when an examination is requested by L&I. | Details → |
| 241 | Low Income Subsidy (LIS) Co-payment Amount Start: 06/03/2012 | Details → |
| 241 | Not payable when injured worker is receiving time-loss compensation or has been kept … | Details → |
| 242 | Services not provided by network/primary care providers. Start: 06/03/2012 | Last Mo… | Details → |
| 242 | Bill contains multiple charges for dates when claim was not open. Delete services and… | Details → |
| 243 | Services not authorized by network/primary care providers. Start: 06/03/2012 | Last … | Details → |
| 243 | Denied. Please submit a paper bill to James L. Groves Company, Seattle. | Details → |
| 244 | Payment reduced to zero due to litigation. Additional information will be sent follow… | Details → |
| 244 | Denied. injured worker is not eligible under this claim for this date(s) of service. | Details → |
| 245 | Provider performance program withhold. Start: 09/30/2012 | Details → |
| 245 | Denied. Please rebill these services on an outpatient bill. | Details → |
| 246 | This non-payable code is for required reporting only. Start: 09/30/2012 | Details → |
| 246 | Denied. Procedure and/or modifier code is incorrect for service described on bill. | Details → |
| 247 | Deductible for Professional service rendered in an Institutional setting and billed o… | Details → |
| 247 | When multiple modifiers apply, use 99 & list all applicable modifiers in the descript… | 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.