This service is allowed 2 times in a 12-month period.
Code type
RARC (Remark)
Category
Benefit Maximum/Limitation
Common CARC pairings
RARC N412 appears with a Claim Adjustment Reason Code (CARC) on the 835 electronic remittance advice and gives more detail about the adjustment. These are the CARCs most often paired with RARC N412.
| CARC | Meaning |
|---|---|
| 119 | Benefit maximum for this time period or occurrence has been reached. |
| 222 | Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 273 | Coverage/program guidelines were exceeded. |
See the full resolution workflow for RARC N412
Members of the EDI-Code Intelligence Lab get the step-by-step rework path, appeal language, root-cause drivers, and prevention checklist for every RARC and CARC pairing, plus payer-specific requirements.
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