CARC 24: Charges are covered under a capitation agreement/managed care plan.
The provider is being paid via a per-member-per-month capitation arrangement, not fee-for-service. Patient owes nothing for this code.
CARC 24 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 24 means
The official X12 description is: “Charges are covered under a capitation agreement/managed care plan.”
In plain language: The provider is being paid via a per-member-per-month capitation arrangement, not fee-for-service. Patient owes nothing for this code.
Common scenarios
- Kaiser-style integrated delivery
- HMO PCP visits under capitation
- Medicare Advantage cap arrangements
Practice workflow for CARC X 24
No patient action required. If a provider bills you for this, it's likely an error — contact your plan.
CARC 24 group codes explained
On the 835 ERA, CARC 24 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 24 mean?
Charges are covered under a capitation agreement/managed care plan. In plain language: The provider is being paid via a per-member-per-month capitation arrangement, not fee-for-service. Patient owes nothing for this code.
Is CARC 24 appealable?
CARC 24 is usually not appealable on its own — it's typically a contractual, informational, or routine adjustment. No patient action required. If a provider bills you for this, it's likely an error — contact your plan.
Which group code does CARC 24 appear under?
CARC 24 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 24 typically appear on a denial?
Common scenarios: Kaiser-style integrated delivery; HMO PCP visits under capitation; Medicare Advantage cap arrangements.
What should I do if I see CARC 24 on the 835?
No patient action required. If a provider bills you for this, it's likely an error — contact your plan.
Related resources
Sources
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