The procedure or service is inconsistent with the patient's history.
Group code
CO, PI or PR
Category
Coding
Risk level
High
Appealable
Yes
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 261 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| N56 | Procedure code billed is not correct/valid for the services billed or the date of service billed. |
See the full resolution workflow for CARC 261
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