Denial Code Lookup Tool
Covers 18 of the most common CARC/RARC denial codes billers actually see on remittances. Search by code or keyword and get a plain-English answer instead of digging through a payer manual.
Denial Code Lookup
Type a code (CO 45, PR 119) or a keyword from your remittance and get an instant, plain-English answer: what it means, who owes the balance, and what to do next.
Showing all 18 codes in the library. Start typing to filter.
Claim lacks information or has a submission error.
“Claim/service lacks information or has submission/billing error(s) which is needed for adjudication.”
What to do
Read the paired remark code (often M76, N290, or MA04), fix the missing data, and resubmit. Not an appeal situation.
Exact duplicate claim or service.
“Exact duplicate claim/service.”
What to do
Confirm whether the original claim already paid before resubmitting blindly.
Care may be covered by another payer (coordination of benefits).
“This care may be covered by another payer per coordination of benefits.”
What to do
Verify which plan is primary, confirm the patient's other coverage, and rebill in the right order.
Timely filing limit expired.
“The time limit for filing has expired.”
What to do
Appeal only with proof of original timely submission, or documented good cause.
Charge exceeds the contracted fee schedule.
“Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.”
What to do
Usually a routine contractual adjustment. Audit periodically to catch underpayments where the payer's math is wrong.
Not medically necessary per the payer's policy.
“These are non-covered services because this is not deemed a 'medical necessity' by the payer.”
What to do
Appeal with clinical documentation matched point-by-point against the payer's LCD/NCD or medical policy criteria.
Bundled into another paid service.
“The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.”
What to do
Check the NCCI edit pair and the procedure's global period. Add modifier 59/X or 24/58/78/79 only when documentation supports a truly distinct service.
Wrong payer; the claim belongs elsewhere.
“Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.”
What to do
Identify the correct payer or contractor (common with Medicare Advantage vs. traditional Medicare mix-ups) and submit there.
Benefit maximum reached for the period.
“Benefit maximum for this time period or occurrence has been reached.”
What to do
Verify the plan's accumulator is accurate, then bill the patient or check for secondary coverage.
Frequency of services exceeds payer policy.
“Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.”
What to do
Check the payer's frequency limits for the code, and appeal with medical-necessity documentation if the frequency was clinically justified.
Missing prior authorization or precertification.
“Precertification/authorization/notification/pre-treatment absent.”
What to do
Request retroactive authorization where the payer allows it; otherwise appeal with documented cause for the missed auth.
Procedure/modifier combination not compatible (NCCI edit).
“This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative.”
What to do
Review the NCCI edit pair and its modifier indicator. Correct the coding, or apply modifier 59/X only when the services were genuinely distinct.
Medicare sequestration reduction (2%).
“Sequestration - reduction in federal payment.”
What to do
This is an informational federal reduction. Post it as its own adjustment category and never bill the patient for it.
Patient's deductible.
“Deductible amount.”
What to do
Bill the patient; collect at point of service where possible.
Patient's coinsurance.
“Coinsurance amount.”
What to do
Bill the patient; collect at point of service where possible.
Patient's copay.
“Co-payment amount.”
What to do
Bill the patient; collect at point of service where possible.
Coverage terminated before the date of service.
“Expenses incurred after coverage terminated.”
What to do
Re-verify the termination date; if coverage looks active elsewhere, bill that plan. Otherwise bill the patient.
Service not covered under the patient's plan.
“This service/equipment/drug is not covered under the patient's current benefit plan.”
What to do
Confirm benefits, then bill the patient with any required advance notices (e.g. ABN) on file.
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