CARC 2: Coinsurance Amount
Your share of the cost as a percentage (e.g. 20%) after the deductible. Patient responsibility — not a denial.
CARC 2 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 2 means
The official X12 description is: “Coinsurance Amount”
In plain language: Your share of the cost as a percentage (e.g. 20%) after the deductible. Patient responsibility — not a denial.
Common scenarios
- After deductible met
- In-network covered service
- Specialist visit at higher coinsurance tier
Practice workflow for CARC X 2
Pay the amount. If your out-of-pocket maximum was already met, request a corrected EOB — the carrier should have stopped charging coinsurance.
CARC 2 group codes explained
On the 835 ERA, CARC 2 appears alongside a group code that signals who is financially responsible for the adjustment. PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
Frequently asked questions
What does CARC 2 mean?
Coinsurance Amount In plain language: Your share of the cost as a percentage (e.g. 20%) after the deductible. Patient responsibility — not a denial.
Is CARC 2 appealable?
CARC 2 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. Pay the amount. If your out-of-pocket maximum was already met, request a corrected EOB — the carrier should have stopped charging coinsurance.
Which group code does CARC 2 appear under?
CARC 2 most often appears under: PR (Patient Responsibility) — Patient owes this amount. Deductibles, coinsurance, copays, and excluded benefits land here.
When does CARC 2 typically appear on a denial?
Common scenarios: After deductible met; In-network covered service; Specialist visit at higher coinsurance tier.
What should I do if I see CARC 2 on the 835?
Pay the amount. If your out-of-pocket maximum was already met, request a corrected EOB — the carrier should have stopped charging coinsurance.
Related resources
Sources
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