CARC Codes & RARC Codes | List, Examples & Explanation
Below you can find the definition of RARC Codes and CARC Codes, followed by some examples, and you can download a list with CARC codes and RARC codes.
1. What Are CARC Codes?
CARC Codes is an abbreviation often used in medical billing for ‘Claim Adjustment Reason Codes.’ These codes are created to communicate an adjustment. In other words, CARC codes have to explain why a service or claim was paid differently than initially billed.
1.1 Example 1
CARC Code CO 16 explains that the service or claim lacks the information necessary for adjudication. Therefore, a minimum of one RARC code must be provided in this case.
1.2 Example 2
Another example is CARC Code CO 45. This code explains that the charge exceeds the maximum legislated, contracted, or allowable fee schedule/arrangement.
2. What Are RARC Codes?
RARC Codes is another abbreviation: ‘Remittance Advice Remark Codes.’ RARC codes are created to supply information about remittance processing. These codes also explain adjustments described by CARC codes.
2.1. Example 1
RARC Code M25 explains that the information provided does not substantiate the level of the service provided.
2.2 Example 2
Another RARC Code example is M80. This code explained that it is not covered because the service is performed on the same date or during the same session as another already processed service.
3. CARC And RARC Codes List
Medicaid has provided a complete list of all CARC and RARC codes. You can download the list below.
Resources
https://medicaid.utah.gov/Documents/pdfs/ClaimDenialCodes.pdf
