Lifetime benefit maximum has been reached for this service/benefit category.
Group code
CO, PI or PR
Category
Benefit Maximum/Limitation
Risk level
High
Appealable
No
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 149 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N117 | This service is paid only once in a patient's lifetime. |
| N386 | This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy. |
| N587 | Policy benefits have been exhausted. |
| N786 | Benefit limitation for the orthodontic active and/or retention phase of treatment. |
See the full resolution workflow for CARC 149
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every CARC and RARC pairing, plus payer-specific quirks.
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