Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Group code
CO, PI or PR
Category
Benefit Maximum/Limitation
Risk level
Medium
Appealable
Review Required
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 222 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N115 | This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD. |
| N411 | This service is allowed one time in a 6-month period. |
| N412 | This service is allowed 2 times in a 12-month period. |
| N587 | Policy benefits have been exhausted. |
| N633 | Additional anesthesia time units are not allowed. |
| N640 | Exceeds number/frequency approved/allowed within time period. |
| N853 | The number of modalities performed per session exceeds our acceptable maximum. |
See the full resolution workflow for CARC 222
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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