CARC 199: Revenue code and procedure code do not match.
Coding error between the facility billing (revenue code) and the professional billing (procedure code). Provider needs to fix and resubmit.
CARC 199 appears on the 835 ERA (Electronic Remittance Advice) that the payer returns after claim adjudication. It explains a reduction, denial, or payment adjustment to your billing team. For your practice, the question is workflow: identify the pattern, route the denial to the right resolution path (rebill, appeal, write-off), and recover what's recoverable without burning RVU time on dead-end fights.
What CARC 199 means
The official X12 description is: “Revenue code and procedure code do not match.”
In plain language: Coding error between the facility billing (revenue code) and the professional billing (procedure code). Provider needs to fix and resubmit.
Common scenarios
- Hospital billing crosswalk error
- Outpatient code paired with wrong revenue line
Practice workflow for CARC X 199
Provider's billing office issue. Decline to pay until they fix it. Not a clinical denial.
CARC 199 group codes explained
On the 835 ERA, CARC 199 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 199 mean?
Revenue code and procedure code do not match. In plain language: Coding error between the facility billing (revenue code) and the professional billing (procedure code). Provider needs to fix and resubmit.
Is CARC 199 appealable?
CARC 199 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Provider's billing office issue. Decline to pay until they fix it. Not a clinical denial.
Which group code does CARC 199 appear under?
CARC 199 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
When does CARC 199 typically appear on a denial?
Common scenarios: Hospital billing crosswalk error; Outpatient code paired with wrong revenue line.
What should I do if I see CARC 199 on the 835?
Provider's billing office issue. Decline to pay until they fix it. Not a clinical denial.
Related resources
Sources
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