Services by an immediate relative or a member of the same household are not covered.
Group code
CO, PI or PR
Category
Non-Covered Service
Risk level
Medium
Appealable
No
See the full resolution workflow for CARC 53
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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