What does CARC 57 mean?

CARC 57 means "Payment denied/reduced because the payer deems the information submitted does not support this level of service.". The recommended action is: Submit appeal with complete medical records supporting the level of service billed.

How do I resolve CARC 57?

Obtain the complete medical record documenting the clinical need for the service Review the payer's LCD/NCD or coverage policy for the billed procedure Prepare a Letter of Medical Necessity from the treating physician Submit a formal appeal with clinical records, the letter, and peer-reviewed literature Track the appeal and follow up within 30 days

Can CARC 57 be appealed?

CARC 57 has a 35% recovery rate and typically resolves in 21-45 days. Resolution difficulty is rated Hard.

CARC Code

57

🔴 Hard Denial

Payment denied/reduced because the payer deems the information submitted does not support this level of service.

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Common

Frequency

Recommended Action

Submit appeal with complete medical records supporting the level of service billed

Step-by-Step Resolution

1
Obtain the complete medical record documenting the clinical need for the service
2
Review the payer's LCD/NCD or coverage policy for the billed procedure
3
Prepare a Letter of Medical Necessity from the treating physician
4
Submit a formal appeal with clinical records, the letter, and peer-reviewed literature
5
Track the appeal and follow up within 30 days

Common Remark Codes (RARC)

These RARC codes often appear alongside CARC 57 on remittance advice.

RARC N163·Medical record does not support code billed per code definition

→ Submit detailed progress notes supporting level of service billed

Payer-Specific Notes

How major payers handle CARC 57 in practice.

MetLife Dental

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

Common 835 Combinations

CARC 57 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-57Appealable COCO-57+N163Appealable

Look up any combination →

Appeal Letter Template

Enter your email to access the full appeal template for CARC 57.

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 57 indicating: "Payment denied/reduced — info submitted does not support this level of service.." 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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