Injury/illness was the result of an activity that is a benefit exclusion.
Group code
CO, PI or PR
Category
Non-Covered Service
Risk level
Medium
Appealable
No
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 160 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N167 | Charges exceed the post-transplant coverage limit. |
| N356 | Not covered when performed with, or subsequent to, a non-covered service. |
| N425 | Statutorily excluded service(s). |
| N607 | Service provided for non-compensable condition(s). |
| N622 | Not covered based on the date of injury/accident. |
See the full resolution workflow for CARC 160
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.
Open in EDI Lab