CARC 96: Non-covered charge(s).
The service isn't covered under your plan benefits. Often a vague catch-all — check the accompanying RARC for the specific reason and your plan's Summary of Benefits and Coverage.
CARC 96 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 96 means
The official X12 description is: “Non-covered charge(s).”
In plain language: The service isn't covered under your plan benefits. Often a vague catch-all — check the accompanying RARC for the specific reason and your plan's Summary of Benefits and Coverage.
Common scenarios
- Preventive screening recoded as diagnostic
- Mental health visit under-paid vs medical
- Vision benefits unclear
- Excluded benefit category
What to do next 96
Read the RARC remark code (it'll be more specific). If the service should be covered per your SBC, appeal citing the specific benefit language. Common appealable cases: preventive services billed as diagnostic, mental health parity violations, ER visits ruled not-emergent.
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 96 group codes explained
On the 835 ERA, CARC 96 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. PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
Frequently asked questions
What does CARC 96 mean?
Non-covered charge(s). In plain language: The service isn't covered under your plan benefits. Often a vague catch-all — check the accompanying RARC for the specific reason and your plan's Summary of Benefits and Coverage.
Is CARC 96 appealable?
Yes — CARC 96 is one of the codes that commonly supports an appeal. Read the RARC remark code (it'll be more specific). If the service should be covered per your SBC, appeal citing the specific benefit language. Common appealable cases: preventive services billed as diagnostic, mental health parity violations, ER visits ruled not-emergent.
Which group code does CARC 96 appear under?
CARC 96 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount. PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
When does CARC 96 typically appear on a denial?
Common scenarios: Preventive screening recoded as diagnostic; Mental health visit under-paid vs medical; Vision benefits unclear; Excluded benefit category.
How do I appeal a CARC 96 denial?
Read the RARC remark code (it'll be more specific). If the service should be covered per your SBC, appeal citing the specific benefit language. Common appealable cases: preventive services billed as diagnostic, mental health parity violations, ER visits ruled not-emergent.
Related resources
Sources
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