Payment adjusted based on type of technology used.
Code type
RARC (Remark)
Category
Medical Necessity
Common CARC pairings
RARCs like N794 ride alongside CARCs on the 835 electronic remittance advice. These are the CARC denials RARC N794 is most often paired with.
| CARC | Meaning |
|---|---|
| 50 | These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 55 | Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| 204 | This service/equipment/drug is not covered under the patient's current benefit plan. |
See the full resolution workflow for RARC N794
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 quirks.
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