Coverage/program guidelines were not met.
Group code
CO, PI or PR
Category
Medical Necessity
Risk level
High
Appealable
Yes
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 272 on the 835 electronic remittance. These are the RARCs seen most often with this CARC.
| RARC | Meaning |
|---|---|
| M40 | Claim must be assigned and must be filed by the practitioner's employer. |
| N10 | Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. |
| N20 | Service not payable with other service rendered on the same date. |
| 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. |
| N151 | Telephone contact services will not be paid until the face-to-face contact requirement has been met. |
| N357 | Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met. |
| N386 | This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy. |
| N507 | Plan distance requirements have not been met. |
See the full resolution workflow for CARC 272
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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