CARC Code
96
Non-covered charge(s).
38%
Recovery Rate
20-60 days
Avg. Resolution
Medium
Difficulty
Common
Frequency
Recommended Action
Identify remark code, verify coverage, appeal or adjust off
Step-by-Step Resolution
- 1
Identify the accompanying RARC code to understand the specific non-covered reason
- 2
Verify the specific exclusion in the patient's Summary of Benefits
- 3
Determine if this is a plan exclusion or a billing error (wrong code, wrong modifier)
- 4
If billing error: correct the claim and resubmit
- 5
If plan exclusion: obtain ABN if applicable and bill patient with explanation
- 6
If you disagree with the exclusion, file a clinical appeal with supporting documentation
Common Remark Codes (RARC)
These RARC codes often appear alongside CARC 96 on remittance advice.
→ Request plan exclusion list in writing from payer
→ Pull payer clinical policy for the billed service
→ Review NCCI bundling edits; correct modifier usage if appropriate
Payer-Specific Notes
How major payers handle CARC 96 in practice.
Delta Dental
Many group plans have a list of excluded procedures (whitening, implants, ortho without rider)
Cigna Dental
CARC 96 with N130 indicates plan-specific exclusion; request benefit booklet from employer HR
Common 835 Combinations
CARC 96 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
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