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 |
|---|---|---|
| 1021 | Missing form A single case agreement referral form must accompany each claim submitte… | Details → |
| 1023 | Missing OP report Resubmit with OP report. | Details → |
| 1024 | Invalid discharge hour Invalid Discharge Hour | Details → |
| 1025 | ERAP payment Payment denied. Information on file indicates payment was made to anothe… | Details → |
| 1026 | Units billed exceeds auth The number of units billed exceeds the number of units auth… | Details → |
| 1027 | Refund received due to billing error Refund received due to billing error | Details → |
| 1028 | Refund Received resubmit to LifeSynch Refund Received resubmit to LifeSynch | Details → |
| 1029 | Raytel and service location not in box 33 Please resubmit using Raytel's Tax ID and t… | Details → |
| 1030 | Invalid primary or admitting dx code Invalid primary or admitting diagnosis code � pl… | Details → |
| 1031 | Primary dx paired with secondary dx Primary Dx is not acceptable unless paired with a… | Details → |
| 1032 | Billable visit not appropriate level First billable visit not skilled at appropriate … | Details → |
| 1033 | Supply revcodes not on claim Provider billed HHPPS FINAL indicating Medical/Surgical … | Details → |
| 1034 | Revcode requires HCPCS, DOS and amount Revenue code 0274 requires an HCPCS code, the … | Details → |
| 1035 | Cancellation submitted prior to up/downcoding In order to bill new HHPPS HHRG code, a… | Details → |
| 1036 | Unable to adjust RAPS Unable to adjust RAPS. RAPS must be canceled and re-billed in o… | Details → |
| 1037 | No claim in std benefit period No claim in std benefit period before use of reserve d… | Details → |
| 1038 | Other agency responsible for payment Other agency may be responsible for payment | Details → |
| 1040 | Timely filing This claim was submitted after the filing deadline. | Details → |
| 1046 | Invalid specialty for svc Provider specialty invalid for service rendered. | Details → |
| 1049 | Resubmit to TX Mcaid , MCO not responsible for InP Submit Inpatient Acute Care Claims… | Details → |
| 1050 | MOOP This member has reached the max out-of-pocket amount for 2011. If cost-share in … | Details → |
| 1051 | Medicare not reimbursing procedure code This procedure code is not reimbursable throu… | Details → |
| 1052 | Not medically necessary Medical necessity not established for services rendered. | Details → |
| 1053 | Attendant Care Payment Based upon Participation Level, Attendant Care Enhanced Paymen… | Details → |
| 1054 | Resubmit with CMS rate sheet Resubmit claim with a CMS rate sheet. | Details → |
| 1055 | Cancellation recd, claim cancelled. The cancellation claim was received; claim was ca… | Details → |
| 1056 | 327 recd; adjustment adjudicated TOB 327 received; adjustment adjudicated. | Details → |
| 1057 | Billed service to DMERC Service can only be billed to the DMERC. | Details → |
| 1058 | Denied for wrong surgery Claim detail denied due to wrong surgery performed on client | Details → |
| 1059 | Pending Rate Hearing State has not issued procedure code pricing. Claims will be repr… | Details → |
| 1060 | ICRS DRG audit Claim reversal is due to ICRS DRG audit. | Details → |
| 1061 | Resubmit with a DRG Please resubmit your claim with a DRG. | Details → |
| 1062 | Code is Included Services included per CPT Guidelines. | Details → |
| 1064 | CODE CHANGED PROCEDURE CODE CHANGED PER REVIEW | Details → |
| 1065 | INCLUDED IN PRIMARY PROCEDURE INCLUDED IN PRIMARY PROCEDURE | Details → |
| 1066 | PROCEDURE INAPPROPRIATELY CODED PROCEDURE INAPPROPRIATELY CODED | Details → |
| 1067 | NOT A COVERED SERVICE NOT A COVERED SERVICE | Details → |
| 1068 | NOT A COVERED SERVICE FOR PROVIDER SPECIALTY NOT A COVERED SERVICE FOR PROVIDER SPECI… | Details → |
| 1069 | POST-OP FOLLOW-UP INCLUDED WITH GLOBAL FEE POST-OP FOLLOW-UP INCLUDED WITH GLOBAL FEE | Details → |
| 1070 | E & M CODE LEVEL RECODED. E & M CODE LEVEL RECODED. | Details → |
| 1071 | RESUBMIT WITH SUPPORTING DOCUMENTATION RESUBMIT WITH SUPPORTING DOCUMENTATION | Details → |
| 1072 | MULTIPLE ENDOSCOPY RULES MULTIPLE ENDOSCOPY RULES | Details → |
| 1073 | SURGEON AND SURGICAL ASSIST SURGEON AND SURGICAL ASSIST CANNOT BE THE SAME PROVIDER | Details → |
| 1074 | ICD9 DOES NOT SUPPORT PROCEDURE THE ICD9 CODES ON THE CLAIM DO NOT SUPPORT THE BILLED… | Details → |
| 1075 | ONLY ONE E/M CODE ALLOWED PER DAY ONLY ONE E/M CODE ALLOWED PER DAY | Details → |
| 1076 | INCORRECT MODIFIER INCORRECT MODIFIER | Details → |
| 1077 | MULTIPLE ASSIST SURGEONS NOT ALLOWED MORE THAN ONE ASSISTANT SURGEON NOT ALLOWED | Details → |
| 1078 | INCLUDED IN E&M SERVICE INCLUDED IN E&M SERVICE | Details → |
| 1079 | MUTUALLY EXCLUSIVE PROCEDURE MUTUALLY EXCLUSIVE PROCEDURE | Details → |
| 1080 | ONLY ONE SERVICE ALLOWED PER COURSE OF TREATMENT. ONLY ONE SERVICE ALLOWED PER COURSE… | Details → |
| 1081 | ALLOWED AMOUNT GREATER THAN SUBMITTED AMOUNT ALLOWED AMOUNT GREATER THAN SUBMITTED AM… | Details → |
| 1082 | ADD-ON CODE WAS DENIED THE ADD-ON CODE WAS DENIED BECAUSE THE PRIMARY PROCEDURE WAS N… | Details → |
| 1083 | ADJUSTED UNITS ADJUSTED UNITS BECAUSE THEY EXCEEDED THE AMOUNT ALLOWED | Details → |
| 1084 | RECODED TO A GENERAL ANESTHESIA SERVICE CODE RECODED TO A GENERAL ANESTHESIA SERVICE … | Details → |
| 1085 | BLOOD COLLECTION INCLUDED IN LAB SERVICES BLOOD COLLECTION INCLUDED IN LAB SERVICES | Details → |
| 1086 | SERVICE PROCESSED AS A BILATERAL PROCEDURE SERVICE PROCESSED AS A BILATERAL PROCEDURE | Details → |
| 1087 | BILATERAL PROCEDURE INAPPROPRIATELY CODED BILATERAL PROCEDURE INAPPROPRIATELY CODED | Details → |
| 1088 | PROCEDURE BILATERAL IN NATURE PROCEDURE BILATERAL IN NATURE | Details → |
| 1089 | SERVICE DENIED SERVICE DENIED BECAUSE THE RELATED OR QUALIFYING SERVICE WAS NOT PAID … | Details → |
| 1090 | THIS SERVICE IS BUNDLED THIS SERVICE IS BUNDLED INTO SERVICES NOT OTHERWISE SPECIFIED | 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.