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Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update

New Medicare CARC Codes

Code Current Narrative Effective Date (per WPC posting)
231 Mutually exclusive procedures cannot be done in the same day/setting. 1/1/2010

Modified Medicare CARC Codes

Code Current Narrative Effective Date (per WPC posting)
40 Charges do not meet qualifications for emergent/urgent care. 04/01/2010
50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. 4/1/2010
55 Procedure/treatment is deemed experimental/investigational by the payer. 4/1/2010
56 Procedure/treatment has not been deemed 'proven to be effective' by the payer. 4/1/2010
58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. 4/1/2010
59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) 4/1/2010

Deactivated Medicare CARC Codes

Code Current Narrative Effective Date
156 * Flexible spending account payments. Note: Use code 187. 10/1/2009

New Codes - RARC:

Code Current Narrative Medicare Initiated
N519 Invalid combination of HCPCS modifiers. NO
N520 Alert: Payment made from a Consumer Spending Account. NO

SOURCE: Source
INDUSTRY NEWS TAGS: CMS


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