CARC 155: Patient refused the service/procedure.
Patient refused the service/procedure.
CARC 155 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
What CARC 155 means
The official X12 description is: “Patient refused the service/procedure.”
In plain language: Patient refused the service/procedure.
What to do next 155
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
CARC 155 group codes explained
On the 835 ERA, CARC 155 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 155 mean?
Patient refused the service/procedure. In plain language: Patient refused the service/procedure.
Is CARC 155 appealable?
CARC 155 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
Which group code does CARC 155 appear under?
CARC 155 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
What should I do if I see CARC 155 on the 835?
Verify the EOB details. If you believe the code is misapplied, contact the carrier's member services or your provider's billing office.
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