What does CARC 47 mean?

CARC 47 means "This (these) diagnosis(es) is (are) not covered, missing, or are invalid.". The recommended action is: Correct the diagnosis code and resubmit or appeal with documentation.

How do I resolve CARC 47?

Review the plan's Summary of Benefits to confirm the service is excluded Inform the patient in writing that the service is not covered under their plan Determine if an ABN was issued prior to service (required for Medicare) Bill the patient for the non-covered service if an ABN was signed Document the non-coverage determination in the patient account

Can CARC 47 be appealed?

CARC 47 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

47

🔴 Hard Denial

This (these) diagnosis(es) is (are) not covered, missing, or are invalid.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Occasional

Frequency

Recommended Action

Correct the diagnosis code and resubmit or appeal with documentation

Step-by-Step Resolution

1
Review the plan's Summary of Benefits to confirm the service is excluded
2
Inform the patient in writing that the service is not covered under their plan
3
Determine if an ABN was issued prior to service (required for Medicare)
4
Bill the patient for the non-covered service if an ABN was signed
5
Document the non-coverage determination in the patient account

Payer-Specific Notes

How major payers handle CARC 47 in practice.

MetLife Dental

MetLife provides detailed denial reason codes — check EOB for supplemental information.

Appeal Letter Template

Enter your email to access the full appeal template for CARC 47.

We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 47 indicating: "This diagnosis is not covered, missing, or invalid.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.

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