These are non-covered services because this is a pre-existing condition. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
Group code
CO, PI or PR
Category
Non-Covered Service
Risk level
Medium
Appealable
No
Common RARC pairings
RARCs (Remittance Advice Remark Codes) provide the specific reason detail alongside CARC 51 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. |
| N45 | Payment based on authorized amount. |
| N174 | This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'. |
| N204 | Services under review for possible pre-existing condition. Send medical records for prior 12 months. |
| N607 | Service provided for non-compensable condition(s). |
| N849 | Missing Tooth Clause: Tooth missing prior to the member effective date. |
See the full resolution workflow for CARC 51
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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