The reference
Denial Codes, Read by Someone Who Reads Denials
Every code here is the real, published reason a payer gives. For each one: what it actually means, why it happens in practice, and the appeal angle that recovers it. No surveys. No invented percentages. The mechanism and the move.
Claim adjustment reason codes
- CARC 16 Claim Lacks Information or Has Submission Errors The claim is missing a required piece of information or has a submission error.
- CARC 197 Precertification or Authorization Absent Precertification, authorization, or notification was required and was not obtained.
- CARC 50 Not Deemed a Medical Necessity The payer determined the service was not medically necessary as billed.
- CARC 11 Diagnosis Inconsistent With the Procedure The diagnosis on the claim does not support the procedure billed.
- CARC 18 Duplicate Claim or Service The payer identified the claim as a duplicate of one already processed.
- CARC 97 Service Bundled Into Another Payment The service was considered included in the payment for another procedure.
- CARC 29 The Time Limit for Filing Has Expired The claim was submitted after the payer’s filing deadline.
- CARC 96 Non-Covered Charges The payer considers the service not covered under the plan.
- CARC 27 Expenses After Coverage Terminated The payer says coverage had ended before the date of service.
- CARC 4 Procedure Inconsistent With the Modifier The modifier is missing, invalid, or inconsistent with the procedure code.
- CARC 109 Claim Not Covered by This Payer or Contractor The claim was sent to the wrong payer or the wrong plan.
Dental procedure denials
- CDT D0140 Limited Oral Evaluation, Problem Focused A problem-focused limited exam denied, often as a frequency or bundling conflict.
- CDT D4341 Scaling and Root Planing, Four or More Teeth Per Quadrant Periodontal scaling and root planing denied, usually for documentation of disease.
- CDT D2740 Crown, Porcelain or Ceramic A porcelain or ceramic crown denied, often as cosmetic or downgraded to metal.
- CDT D7210 Surgical Removal of an Erupted Tooth A surgical extraction denied or downgraded to a simple extraction.
The patterns that cost the most
The next step
If a number in here matched your practice, that leak is measurable. The 12-Month Missing Money Scan reads your last twelve months of claims and finds the money already earned but never collected. 25% of what is recovered, 20% if you prepay. No recovery, no fee.
Get your 12-Month Missing Money Scan