CARC Code
49
This is a non-covered service because it is a routine/preventive exam or diagnostic/screening procedure done in conjunction with a routine exam.
55%
Recovery Rate
14-30 days
Avg. Resolution
Medium
Difficulty
Occasional
Frequency
Recommended Action
Rebill with appropriate diagnostic code or bill patient as non-covered
Step-by-Step Resolution
- 1
Verify if the service was truly performed in conjunction with a routine/wellness exam
- 2
If the service addressed a separate medical problem, rebill with a distinct diagnostic code
- 3
Separate the routine exam code from the diagnostic service using 25 modifier if same-day visit
- 4
Obtain an ABN from the patient if the service is truly non-covered
- 5
Bill patient for non-covered routine services after obtaining signed ABN
- 6
Educate patient in advance about services not covered at wellness visits
Common Remark Codes (RARC)
These RARC codes often appear alongside CARC 49 on remittance advice.
→ Review annual wellness visit vs. preventive service billing rules
Payer-Specific Notes
How major payers handle CARC 49 in practice.
General
Preventive cleanings are covered; additional scaling/root planing on same day may be bundled
Delta Dental
Exam and X-rays at same visit are covered preventive; additional restorative triggers CARC 49
Common 835 Combinations
CARC 49 most often appears with these Group Code + RARC combinations on 835 remittances.
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