835 Denial Combination
CO-96
Contractual Obligation · Claim-Level Adjustment
Contractual ObligationWhat This Combination Means
The payer has identified charges that are non-covered under the contract, but no specific remark code was included to explain why. This represents a contractual adjustment that the provider must write off, though the absence of a RARC means the specific reason for non-coverage is not documented on this remittance. The provider should reference their contract terms or contact the payer to understand which services or charges triggered this adjustment.
Financial Responsibility
provider writeoff
The provider is contractually obligated to write off the adjusted amount and cannot balance bill the patient for these non-covered charges.
N/A
Appeal Success
Immediate (write-off)
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-96 combination — not generic advice.
- 1
Review the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) for the claim
CARC 96 specifically instructs providers to check this segment for policy information explaining the non-covered determination
- 2
Contact payer for missing RARC documentation
CARC 96 requires at least one remark code, so request clarification on which contract provision or policy makes these charges non-covered
- 3
Post contractual adjustment and write off the amount
Apply the CO-96 adjustment to the patient account as a non-billable contractual write-off per payer agreement
Specialty Context
How CO-96 typically presents across different practice types.
Dental
Common for services excluded from medical-dental coverage boundaries (e.g., TMJ treatment billed to medical insurance) or cosmetic procedures explicitly excluded in dental contracts.
Medical
Frequently appears for experimental treatments, cosmetic procedures, or services listed as contract exclusions; absence of RARC may indicate generic non-covered determination.
Behavioral Health
May apply to court-ordered evaluations, non-clinical case management, or services exceeding benefit plan scope when mental health parity does not apply.
Individual Code References
View the standalone definition for each code in this combination.
Medicare Contractor Guidance for CARC 96
FCSO + NoridianThis denial is received when the service billed is statutorily excluded from coverage under the Medicare program. Payment cannot be made for the service under Part A or Part B.
How to Prevent CARC 96 Denials
- ✓
Review the service billed to ensure the correct code was submitted.
- ✓
If the claim is being submitted for statutorily excluded services, you can append a GY modifier to the line item. The GY modifier indicates that the item or service is statutorily excluded or does not meet the definition of a Medicare benefit.
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