CARC 272: Coverage/program guidelines were not met.
Coverage/program guidelines were not met.
CARC 272 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 272 means
The official X12 description is: “Coverage/program guidelines were not met.”
In plain language: Coverage/program guidelines were not met.
What to do next 272
Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
DenialHelp helps organize a source-linked draft from the denial notice and confirmed case facts. The patient and treating clinician must verify the governing review rule, current payer policy, clinical sources, attachments, destination, and deadline.
CARC 272 group codes explained
On the 835 ERA, CARC 272 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 272 mean?
Coverage/program guidelines were not met. In plain language: Coverage/program guidelines were not met.
Is CARC 272 appealable?
Yes — CARC 272 is one of the codes that commonly supports an appeal. Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
Which group code does CARC 272 appear under?
CARC 272 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
How do I appeal a CARC 272 denial?
Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
Related resources
Sources
Appeal a CARC 272 denial
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