Denial Code Lookup
Every Claim Adjustment Reason Code (CARC) and Remittance Advice Remark Code (RARC) from the official X12 lists, explained in plain English: what it means, common causes, how to fix it, and whether it is still active.
407 reason codes (110 deactivated) · 1216 remark codes (79 deactivated) · X12 lists retrieved September 25, 2026
Most searched codes
- CO-16Claim/service lacks information or has submission/billing error(s).
- CO-45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
- CO-97The benefit for this service is included in the payment/allowance for another…
- CO-4The procedure code is inconsistent with the modifier used.
- CO-197Precertification/authorization/notification/pre-treatment absent.
- CO-50These are non-covered services because this is not deemed a 'medical necessity' by the…
- OA-22This care may be covered by another payer per coordination of benefits.
- OA-18Exact duplicate claim/service (Use only with Group Code OA except where state workers'…
- CO-29The time limit for filing has expired.
- PR-1Deductible Amount
- PR-2Coinsurance Amount
- PR-3Co-payment Amount
- PR-204This service/equipment/drug is not covered under the patient's current benefit plan
- OA-23The impact of prior payer(s) adjudication including payments and/or adjustments. (Use…
- CO-B7This provider was not certified/eligible to be paid for this procedure/service on this…
- CO-11The diagnosis is inconsistent with the procedure.
- CO-96Non-covered charge(s).
- CO-151Payment adjusted because the payer deems the information submitted does not support this…
- CO-167This (these) diagnosis(es) is (are) not covered.
- CO-170Payment is denied when performed/billed by this type of provider.
- CO-236This procedure or procedure/modifier combination is not compatible with another…
- CO-252An attachment/other documentation is required to adjudicate this claim/service.
- PR-27Expenses incurred after coverage terminated.
- CO-109Claim/service not covered by this payer/contractor.
- N290Missing/incomplete/invalid rendering provider primary identifier.
- N130Consult plan benefit documents/guidelines for information about restrictions for this…
- MA130Your claim contains incomplete and/or invalid information, and no appeal rights are…
- M15Separately billed services/tests have been bundled as they are considered components of…
- N20Service not payable with other service rendered on the same date.
- N286Missing/incomplete/invalid referring provider primary identifier.
- N382Missing/incomplete/invalid patient identifier.
- M51Missing/incomplete/invalid procedure code(s).
- N30Patient ineligible for this service.
- MA04Secondary payment cannot be considered without the identity of or payment information…
Browse the full lists
How to read a denial code
A code like CO-16 has two parts. The letters are the group code, which says who is responsible for the adjusted amount. The number is the reason code (CARC), which says why the claim or line was adjusted. A remark code (RARC), such as N290, often follows to give the specific detail.
- CO Contractual Obligation
- The provider is responsible for the adjusted amount under a contract or regulation. It is written off and generally cannot be billed to the patient.
- PR Patient Responsibility
- The patient may owe the amount, such as a deductible, coinsurance, or co-payment. It can be billed to the patient according to the plan and your agreements.
- OA Other Adjustment
- Used when neither CO nor PR applies, for example amounts already considered by a prior payer in coordination of benefits.
- PI Payer Initiated Reduction
- The payer reduced the amount for a reason it considers outside the patient's responsibility, where no contract applies. Whether the patient can be billed depends on the situation and the payer.
- CR Correction and Reversal
- Corrections and reversals of prior claims. It is not part of the current (5010) version of the 835, so it appears only on older remittances.
For a deeper walkthrough, read how to use CARC and RARC codes to analyze denials.
Denial code FAQ
What is a denial code?
A denial code is the Claim Adjustment Reason Code (CARC) a payer puts on an electronic remittance advice (ERA, or 835) or explanation of benefits to explain why a claim or service line was paid differently than billed. It is combined with a group code such as CO or PR, which is why codes appear as CO-45 or PR-1.
What is the difference between a CARC and a RARC?
A CARC gives the reason for the adjustment. A Remittance Advice Remark Code (RARC), such as N290 or MA130, adds detail about that reason, like which claim field was missing. Many CARCs require at least one RARC.
What do CO, PR, OA, and PI mean in front of a code?
They are group codes that say who is financially responsible for the adjusted amount. CO means a contractual obligation the provider writes off, PR means patient responsibility, OA means other adjustment, and PI means a payer-initiated reduction.
What happens to a code that X12 deactivates?
Payers should stop using it on new remittances after the deactivation date, but it can still appear on older ERAs, reprocessed claims, and appeals. Every deactivated code keeps its page here, clearly marked, with the replacement code when X12 names one.