APPENDIX D

Remittance Advice Claim Adjustment Reason Codes

Tell Me Why

Claim Adjustment Reason Codes (CARCs) appear on the remittance advice received by your doctor to tell him why his claim for services he provided to you has been rejected and not paid. The rejection reason can determine whether it is appropriate for him to appeal or bill you instead. The reason codes may also appear on the “explanation of benefits” (EOB) you receive. These codes are maintained by the Washington Publishing Company and are updated three times a year.1 The following table explains some of the most commonly used reason codes and the rejection categories they represent.

Code

Description

Category

4

Procedure code inconsistent with modifier or modifier missing ...

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