CARC 24: Charges are covered under a capitation agreement/managed care plan.
The provider is being paid via a per-member-per-month capitation arrangement, not fee-for-service. Patient owes nothing for this code.
CARC 24 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 24 means
The official X12 description is: “Charges are covered under a capitation agreement/managed care plan.”
In plain language: The provider is being paid via a per-member-per-month capitation arrangement, not fee-for-service. Patient owes nothing for this code.
Common scenarios
- Kaiser-style integrated delivery
- HMO PCP visits under capitation
- Medicare Advantage cap arrangements
What to do next 24
No patient action required. If a provider bills you for this, it's likely an error — contact your plan.
CARC 24 group codes explained
On the 835 ERA, CARC 24 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 24 mean?
Charges are covered under a capitation agreement/managed care plan. In plain language: The provider is being paid via a per-member-per-month capitation arrangement, not fee-for-service. Patient owes nothing for this code.
Is CARC 24 appealable?
CARC 24 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. No patient action required. If a provider bills you for this, it's likely an error — contact your plan.
Which group code does CARC 24 appear under?
CARC 24 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
When does CARC 24 typically appear on a denial?
Common scenarios: Kaiser-style integrated delivery; HMO PCP visits under capitation; Medicare Advantage cap arrangements.
What should I do if I see CARC 24 on the 835?
No patient action required. If a provider bills you for this, it's likely an error — contact your plan.
Related resources
Sources
Contact: hello@denialhelp.com