Service not payable per managed care contract.
Group code
CO, PI or PR
Category
Plan Provision
Risk level
High
Appealable
Rarely
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 256 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M14 | No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection. |
| M37 | Not covered when the patient is under age 35. |
| M61 | We cannot pay for this as the approval period for the FDA clinical trial has expired. |
| M81 | You are required to code to the highest level of specificity. |
| M82 | Service is not covered when patient is under age 50. |
| M89 | Not covered more than once under age 40. |
| M90 | Not covered more than once in a 12 month period. |
| M96 | The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only. |
See the full resolution workflow for CARC 256
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