What does CARC 50 mean?

CARC 50 means "These are non-covered services because this is not deemed a 'medical necessity' by the payer.". The recommended action is: Appeal with clinical documentation supporting medical necessity.

How do I resolve CARC 50?

Obtain the payer's medical necessity criteria or LCD (Local Coverage Determination) for the service Pull the full clinical record: physician notes, labs, imaging, prior treatments, and history Write a letter of medical necessity from the treating provider addressing each criterion Submit a formal appeal within 30-60 days of denial with all clinical documentation attached Escalate to peer-to-peer review if initial appeal denied — request to speak with payer medical director If peer-to-peer fails, file a state insurance department complaint for inappropriate denial

Can CARC 50 be appealed?

CARC 50 has a 48% recovery rate and typically resolves in 30-90 days. Resolution difficulty is rated Hard.

CARC Code

50

🔴 Hard Denial

These are non-covered services because this is not deemed a 'medical necessity' by the payer.

48%

Recovery Rate

30-90 days

Avg. Resolution

Hard

Difficulty

Common

Frequency

Recommended Action

Appeal with clinical documentation supporting medical necessity

Step-by-Step Resolution

1
Obtain the payer's medical necessity criteria or LCD (Local Coverage Determination) for the service
2
Pull the full clinical record: physician notes, labs, imaging, prior treatments, and history
3
Write a letter of medical necessity from the treating provider addressing each criterion
4
Submit a formal appeal within 30-60 days of denial with all clinical documentation attached
5
Escalate to peer-to-peer review if initial appeal denied — request to speak with payer medical director
6
If peer-to-peer fails, file a state insurance department complaint for inappropriate denial

Common Remark Codes (RARC)

These RARC codes often appear alongside CARC 50 on remittance advice.

RARC N1·Alert: Refer to provider manual for additional guidance

→ Pull LCD/NCD from CMS website for the specific procedure

RARC N115·Missing/incomplete/invalid ordering provider information

→ Ensure ordering provider name and NPI are on claim with medical necessity letter

Payer-Specific Notes

How major payers handle CARC 50 in practice.

Delta Dental

Periodontal treatment requires documentation of pocket depths, bone loss, and failed conservative therapy

Cigna Dental

Full mouth reconstruction requires pre-authorization and narrative of existing conditions

MetLife Dental

Medical necessity for implants requires documentation of bone loss and inability to wear denture

Common 835 Combinations

CARC 50 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-50Appealable COCO-50+N115Appealable COCO-50+N163Appealable COCO-50+N130Appealable COCO-50+M86Appealable COCO-50+N518Appealable COCO-50+N130+N115Appealable COCO-50+N567Appealable

Look up any combination →

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