CARC 274: Fee/Service not payable per patient Care Coordination arrangement.
Fee/Service not payable per patient Care Coordination arrangement.
CARC 274 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 274 means
The official X12 description is: “Fee/Service not payable per patient Care Coordination arrangement.”
In plain language: Fee/Service not payable per patient Care Coordination arrangement.
What to do next 274
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 274 group codes explained
On the 835 ERA, CARC 274 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 274 mean?
Fee/Service not payable per patient Care Coordination arrangement. In plain language: Fee/Service not payable per patient Care Coordination arrangement.
Is CARC 274 appealable?
Yes — CARC 274 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 274 appear under?
CARC 274 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 274 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 274 denial
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