This service/equipment/drug is not covered under the patient's current benefit plan.
Group code
CO, PI or PR
Category
Non-Covered Service
Risk level
Medium
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 204 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N10 | Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. |
| N12 | Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare. |
| N129 | Not eligible due to the patient's age. |
| N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. |
| N157 | Transportation to/from this destination is not covered. |
| N158 | Transportation in a vehicle other than an ambulance is not covered. |
| N171 | Payment for repair or replacement is not covered or has exceeded the purchase price. |
| N357 | Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met. |
See the full resolution workflow for CARC 204
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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