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 |
|---|---|---|
| 248 | Coinsurance for Professional service rendered in an Institutional setting and billed … | Details → |
| 248 | Allowed charges reduced to office call. Report billed and paid under 99080. | Details → |
| 249 | This claim has been identified as a readmission. (Use only with Group Code CO) Start… | Details → |
| 249 | Reimbursed at rate of exchange in effect at the time of service. | Details → |
| 250 | The attachment/other documentation that was received was the incorrect attachment/doc… | Details → |
| 250 | Denied by L&I due to lack of identifying information as to provider of services. | Details → |
| 251 | Procedure code 72140 is invalid, use codes 72141 through 72144 to bill for spinal MRI… | Details → |
| 251 | The attachment/other documentation that was received was incomplete or deficient. The… | Details → |
| 252 | Claim closed. Only services requested by L&I are payable. | Details → |
| 252 | An attachment/other documentation is required to adjudicate this claim/service. At le… | Details → |
| 253 | Use revenue codes 430 through 439 to bill occupational therapy. Do not bill with CPT … | Details → |
| 253 | Sequestration - reduction in federal payment Start: 06/02/2013 | Last Modified: 11/0… | Details → |
| 254 | Patient status code 30 invalid for DRG bill; correct and resubmit or submit final bil… | Details → |
| 254 | Claim received by the dental plan, but benefits not available under this plan. Submit… | Details → |
| 255 | Denied, condition code invalid. L&I accepts 00 or 61 for inpatient, all national-vali… | Details → |
| 255 | The disposition of the related Property & Casualty claim (injury or illness) is pendi… | Details → |
| 256 | Service not payable per managed care contract. Start: 06/02/2013 | Details → |
| 256 | Claim now closed. | Details → |
| 257 | The disposition of the claim/service is undetermined during the premium payment grace… | Details → |
| 257 | Principal diagnosis code unacceptable according to Medicare Code Editor. Correct and … | Details → |
| 258 | Claim/service not covered when patient is in custody/incarcerated. Applicable federal… | Details → |
| 258 | Credit taken to offset previous payment made by gross adjustment. | Details → |
| 259 | Additional payment for Dental/Vision service utilization. Start: 01/26/2014 | Details → |
| 259 | Denied. Claim number/injured worker name mismatch. Call 1-800-831-5227 to confirm cla… | Details → |
| 260 | Processed under Medicaid ACA Enhanced Fee Schedule Start: 01/26/2014 | Details → |
| 260 | Service was for concurrent treatment which has not been authorized for this injury. | Details → |
| 261 | The procedure or service is inconsistent with the patient's history. Start: 06/01/20… | Details → |
| 261 | Generically priced. Prescribing doctor hasn't submitted justification to issue brand … | Details → |
| 262 | Adjustment for delivery cost. Usage: To be used for pharmaceuticals only. Start: 11/… | Details → |
| 262 | ICD procedure code(s) invalid for first date of service. Correct and resubmit. | Details → |
| 263 | Adjustment for shipping cost. Usage: To be used for pharmaceuticals only. Start: 11/… | Details → |
| 263 | Denied. Duplicate claim number. Contact L&I local office for the correct number. | Details → |
| 264 | Adjustment for postage cost. Usage: To be used for pharmaceuticals only. Start: 11/0… | Details → |
| 264 | Claim not yet allowed. Bill on hold for claim decision. Do not send rebill, adjustmen… | Details → |
| 265 | Adjustment for administrative cost. Usage: To be used for pharmaceuticals only. Star… | Details → |
| 265 | Denied. Service rendered after date of pension and no treatment order has been author… | Details → |
| 266 | Adjustment for compound preparation cost. Usage: To be used for pharmaceuticals only.… | Details → |
| 266 | Per contract- "Free" trial of transcutaenous nerve stimulator.CO 108 | Details → |
| 267 | Claim/service spans multiple months. At least one Remark Code must be provided (may b… | Details → |
| 267 | Denied. This is a medical contract claim. Submit your bill to the employer contract c… | Details → |
| 268 | The Claim spans two calendar years. Please resubmit one claim per calendar year. Sta… | Details → |
| 268 | Denied. Travel expense must be billed to L&I within 12 months of the date of travel. | Details → |
| 269 | Anesthesia not covered for this service/procedure. Usage: Refer to the 835 Healthcare… | Details → |
| 269 | All ICD operating room procedure codes are non-specific. Correct and resubmit. | Details → |
| 270 | Claim received by the medical plan, but benefits not available under this plan. Submi… | Details → |
| 270 | Injured worker's age invalid for diagnosis. Correct and resubmit. | Details → |
| 271 | Prior contractual reductions related to a current periodic payment as part of a contr… | Details → |
| 271 | Denied. Sum of line item charges does not equal total billed charge. Correct and resu… | Details → |
| 272 | Coverage/program guidelines were not met. Start: 11/01/2015 | Details → |
| 272 | Please note when billing this procedure code enter 001 in bill's units of service fie… | Details → |
| 273 | Coverage/program guidelines were exceeded. Start: 11/01/2015 | Details → |
| 273 | Please note the provider number. Use this number to bill for psychiatric unit service… | Details → |
| 274 | Fee/Service not payable per patient Care Coordination arrangement. Start: 11/01/2015 | Details → |
| 274 | Please note the provider number. Use this number to bill for alcohol unit service. | Details → |
| 275 | Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-paymen… | Details → |
| 275 | Denied as duplicate. The service(s) where paid under your previous provider number. | Details → |
| 276 | Services denied by the prior payer(s) are not covered by this payer. Start: 11/01/20… | Details → |
| 276 | Denied. The diagnosis listed on your billing has not been accepted as related to this… | Details → |
| 277 | The disposition of the claim/service is undetermined during the premium payment grace… | Details → |
| 277 | Denied. Authorization of this procedure, drug or service has been denied under this c… | 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.