RARC codes (Remittance Advice Remark Codes)

Remittance Advice Remark Codes (RARCs) provide additional explanation for an adjustment, or convey information that doesn’t fit a CARC. They appear in the LQ segment of the 835. RARCs are maintained by CMS on behalf of the industry and the list is updated periodically. This page covers the high-frequency working set. The authoritative list is published at x12.org/codes/remittance-advice-remark-codes. Check it for codes not listed here and for current definitions.

What RARCs do

RARCs fall into two types:

Type	Prefix	Purpose
Supplemental	`M`, `N`	Explains an adjustment further, always alongside a CARC
Informational	`Alert:` prefix in the description	Conveys information without an adjustment

A RARC can supply the detail missing from a general CARC. CARC 16 says that information is missing, while the accompanying RARC may identify the exact field or document the payer needs.

Read the RARC before working CARC 16, 96, 125, or 252. Those CARCs are broad, and the RARC may provide the specific reason or requested information.

High-frequency N-series

RARC	Meaning
N4	Missing/incomplete/invalid prior insurance carrier EOB
N19	Procedure code incidental to the primary procedure
N20	Service not payable with other service rendered the same day
N30	Patient ineligible for this service
N54	Claim information is inconsistent with pre-certified/authorized services
N56	Procedure code billed is not correct/valid for the services billed or the date of service
N130	Consult plan benefit documents/guidelines for information about restrictions; the RARC that often accompanies frequency limits and other benefit-design adjustments
N179	Additional information has been requested from the member
N180	This item or service does not meet the criteria for the category under which it was billed
N210	You may appeal this decision
N211	You may not appeal this decision
N290	Missing/incomplete/invalid rendering provider primary identifier
N291	Missing/incomplete/invalid rendering provider secondary identifier
N347	Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider
N362	The number of days or units of service exceeds our acceptable maximum
N381	Consult our contractual agreement for restrictions/billing/payment information
N418	Misrouted claim, see the payer’s claims submission instructions
N448	This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement
N522	Duplicate of a claim processed or in process as a crossover/coordination of benefits claim
N657	This should be billed with the appropriate code for these services

High-frequency M-series

RARC	Meaning
M15	Separately billed services/tests have been bundled as they are considered components of the same procedure
M20	Missing/incomplete/invalid HCPCS; crossover claims only
M25	The information furnished does not substantiate the need for this level of service
M51	Missing/incomplete/invalid procedure code(s)
M54	Missing/incomplete/invalid total charges
M67	Missing/incomplete/invalid other procedure code(s)
M76	Missing/incomplete/invalid diagnosis or condition
M77	Missing/incomplete/invalid/inappropriate place of service
M79	Missing/incomplete/invalid charges on the claim
M80	Not covered when performed during the same session/date as a previously processed service for the patient
M81	You are required to code to the highest level of specificity
M127	Missing patient medical record for this service. In dental, this often indicates that the payer wants charting or radiographs
MA04	Secondary payment cannot be considered without the identity of, or payment information from, the primary payer
MA13	Alert: you may be subject to penalties if you bill the patient for amounts not reported with patient responsibility group code
MA61	Missing/incomplete/invalid Social Security number or health insurance claim number
MA130	Your claim contains incomplete and/or invalid information; no appeal rights, submit a new claim

MA130 reports an incomplete or invalid claim with no appeal rights. Correct the issue and submit a new claim promptly so the filing window does not expire.MA13 is a warning that billing the patient for a non-PR amount can carry penalties. If you see it, check your group code mapping.

Appeal rights signals

Two RARCs tell you directly whether an appeal is available:

RARC	Meaning
N210	You may appeal this decision
N211	You may not appeal this decision
MA130	Incomplete/invalid, no appeal rights; submit a new claim

Check these codes before starting an appeal.

Working with RARCs

Read the RARC before working a generic CARC

CARC 16, 96, 125, and 252 are generic by design.

Check for appeal-rights RARCs

N210, N211, MA130 determine whether an appeal is even available.

Include the RARC in your denial root-cause tagging

“CARC 16” is not a root cause. “CARC 16 / N290, missing rendering provider NPI” is.

Look up anything unfamiliar before posting

Do not guess at a RARC’s meaning. The authoritative list is public.

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Glossary & Appendices

RARC codes (Remittance Advice Remark Codes)

What RARCs do

High-frequency N-series

High-frequency M-series

Appeal rights signals

Working with RARCs

​What RARCs do

​High-frequency N-series

​High-frequency M-series

​Appeal rights signals

​Working with RARCs

What RARCs do

High-frequency N-series

High-frequency M-series

Appeal rights signals

Working with RARCs