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 |
|---|---|---|
| 1151 | HCPCS CODE NOT APPROPRIATE FOR PROFESSIONAL BILLI HCPCS CODE NOT APPROPRIATE FOR PROF… | Details → |
| 1152 | NOT COVERED FOR DIAGNOSIS INDICATED NOT COVERED FOR DIAGNOSIS INDICATED | Details → |
| 1153 | PLACE OF SERVICE INAPPROPRIATE FOR PROCEDURE PLACE OF SERVICE INAPPROPRIATE FOR PROCE… | Details → |
| 1154 | NEW PATIENT VISIT ALLOWED ONCE PER 3 YEARS NEW PATIENT VISIT ALLOWED ONCE PER 3 YEARS | Details → |
| 1155 | MULTIPLE PHYSICIANS/ASSISTANTS MULTIPLE PHYSICIANS/ASSISTANTS ARE NOT COVERED IN THIS… | Details → |
| 1156 | CO-SURGEONS NOT ALLOWED FOR THIS PROCEDURE. CO-SURGEONS NOT ALLOWED FOR THIS PROCEDUR… | Details → |
| 1157 | NOT COVERED BY PROV IN POS NOT COVERED WHEN PERFORMED BY THIS PROVIDER IN THIS PLACE … | Details → |
| 1158 | NOT SEPARATELY REIMBURSABLE UNDER OPPS THE SERVICES REPORTED ON THIS CLAIM ARE NOT SE… | Details → |
| 1159 | NOT CONSIDERED SAFE AND/OR EFFECTIVE. NOT CONSIDERED SAFE AND/OR EFFECTIVE. | Details → |
| 1160 | PROCEDURE RECODED TO DELIVERY ONLY SERVICES PROCEDURE RECODED TO DELIVERY ONLY SERVIC… | Details → |
| 1161 | DOES NOT MEET CRITERIA FOR OBSERVATION SERVICES DOES NOT MEET CRITERIA FOR OBSERVATIO… | Details → |
| 1162 | PAYABLE ONLY WITH ACTIVE INTERVENTION PAYABLE ONLY WITH ACTIVE INTERVENTION | Details → |
| 1163 | PART OF ANOTHER PROCEDURE THIS SERVICE IS CONSIDERED PART OF ANOTHER PROCEDURE PERFOR… | Details → |
| 1164 | CODE BILLED IS NOT CORRECT/VALID PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE S… | Details → |
| 1165 | PROFESSIONAL COMPONENT NOT PAYABLE PROFESSIONAL COMPONENT NOT PAYABLE FOR THIS PLACE … | Details → |
| 1166 | MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS CO MISSING/INCOMPLETE/INVALID PRINCIPA… | Details → |
| 1167 | PARTIAL HOSPITALIZATION NOT INDICATED PARTIAL HOSPITALIZATION NOT INDICATED | Details → |
| 1168 | PROCEDURE INAPPROPRIATELY CODED PROCEDURE INAPPROPRIATELY CODED | Details → |
| 1169 | PROCEDURE INCLUDED WITH E/M SERVICE PROCEDURE INCLUDED WITH E/M SERVICE | Details → |
| 1170 | PROCEDURE INVALID FOR MEDICARE PURPOSES PROCEDURE INVALID FOR MEDICARE PURPOSES | Details → |
| 1171 | PACKAGED INCIDENTAL SERVICE PACKAGED INCIDENTAL SERVICE | Details → |
| 1172 | CONDITION CODE NOT APPROPRIATE FOR BILL TYPE CONDITION CODE NOT APPROPRIATE FOR BILL … | Details → |
| 1173 | DUPLICATE SUBMISSION DUPLICATE SUBMISSION | Details → |
| 1174 | DUPLICATE OF A NEW OR DELETED PROCEDURE CODE DUPLICATE OF A NEW OR DELETED PROCEDURE … | Details → |
| 1175 | QUESTIONABLE SERVICE QUESTIONABLE SERVICE | Details → |
| 1176 | INVALID ICD9 DIAGNOSIS CODE ON CLAIM. CORRECT AND INVALID ICD9 DIAGNOSIS CODE ON CLAI… | Details → |
| 1177 | MULTIPLE PROCEDURE REDUCTION FOR RADIOLOGY MULTIPLE PROCEDURE REDUCTION FOR RADIOLOGY | Details → |
| 1178 | INCLUDED IN RADIATION TREATMENT MANAGEMENT SERVIC INCLUDED IN RADIATION TREATMENT MAN… | Details → |
| 1179 | REVENUE CODE AND HCPCS DO NOT MATCH REVENUE CODE AND HCPCS DO NOT MATCH | Details → |
| 1180 | HCPCS RECODED PER HEALTH PLAN POLICY HCPCS RECODED PER HEALTH PLAN POLICY | Details → |
| 1181 | RECODED RECODED TO A CODE THAT MORE ACCURATELY DESCRIBES THE SERVICES RENDERED | Details → |
| 1182 | RETURN TO OR PAYMENT ADJUSTMENT RETURN TO OR PAYMENT ADJUSTMENT | Details → |
| 1183 | INCLUDED IN BLOOD/BLOOD PRODUCT REVENUE CODE INCLUDED IN BLOOD/BLOOD PRODUCT REVENUE … | Details → |
| 1184 | REVENUE CODE DOES NOT MATCH BILL TYPE REVENUE CODE DOES NOT MATCH BILL TYPE | Details → |
| 1185 | REVENUE CODE INAPPROPRIATELY CODED REVENUE CODE INAPPROPRIATELY CODED | Details → |
| 1186 | REVENUE CODE REQUIRES HCPCS CODE REVENUE CODE REQUIRES HCPCS CODE | Details → |
| 1187 | REVENUE CODE NOT RECOGNIZED BY MEDICARE REVENUE CODE NOT RECOGNIZED BY MEDICARE | Details → |
| 1188 | SERVICE DENIED SERVICE DENIED BECAUSE OF POTENTIAL INTERACTION WITH ANOTHER DRUG ADMI… | Details → |
| 1189 | SEPARATE PAYMENT FOR SERVICES NOT PROVIDED BY MED SEPARATE PAYMENT FOR SERVICES NOT P… | Details → |
| 1190 | CPT SEPARATE PROCEDURE POLICY CPT SEPARATE PROCEDURE POLICY | Details → |
| 1191 | PRE AND INTRA OPERATIVE CARE PAYMENT INCLUDES SERVICES FOR PRE AND INTRA OPERATIVE CA… | Details → |
| 1192 | SERVICE PREVIOUSLY PROCESSED SERVICE PREVIOUSLY PROCESSED AND PAID TO THE SAME OR DIF… | Details → |
| 1193 | SAME/SIMILAR SERVICE PERFORMED RECENTLY SAME/SIMILAR SERVICE PERFORMED RECENTLY | Details → |
| 1194 | TECHNICAL SERVICES NOT PAYABLE FOR THIS PLACE OF TECHNICAL SERVICES NOT PAYABLE FOR T… | Details → |
| 1195 | TEAM SURGERY NOT ALLOWED TEAMSURGERY NOT ALLOWED | Details → |
| 1196 | TERMINATED PROCEDURE CANNOT BE BILLED BILATERALLY TERMINATED PROCEDURE CANNOT BE BILL… | Details → |
| 1197 | TECHNICAL/ PROFESSIONAL SERVICE INAPPROPRIATELY C TECHNICAL/ PROFESSIONAL SERVICE INA… | Details → |
| 1198 | Auth Modifier MisMatch Please resubmit the claim. The modifier(s) billed on the claim… | Details → |
| 1199 | No PCP assignment CALL 1-800-291-0396 TO SELECT A PCP | Details → |
| 1200 | Referral Required Benefit requires an authorization or referral | Details → |
| 1201 | Missing/Invalid TPI Please resubmit with a valid Texas Provider Identification (TPI) … | Details → |
| 1202 | Provider is not certified/eligible This provider was not certified/eligible to be pai… | Details → |
| 1203 | Included in composite rate Services are included in composite rate | Details → |
| 1205 | Rendering NPI Please resubmit with a Valid Billing Provider NPI | Details → |
| 1206 | Medicaid/ Copay and Deductible This member�s coverage through HealthSpring is for lon… | Details → |
| 1207 | Provider Mismatch Provider name in box 33 does not match the NPI and/ or Tax Id submi… | Details → |
| 1208 | Valid Rendering NPI Please resubmit with Valid Rendering Provider NPI | Details → |
| 1209 | C Pend 1 The Requested EOB was not received within the allotted timeframe. | Details → |
| 1210 | C Pend 2 The Requested Operative Note was not received within the allotted timeframe. | Details → |
| 1211 | C Pend 3 The Requested Invoice was not received within the allotted timeframe. | 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.