CARC 274: Fee/Service not payable per patient Care Coordination arrangement.

CARC 274 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 274 means

The official X12 description is: “Fee/Service not payable per patient Care Coordination arrangement.”

In plain language: Fee/Service not payable per patient Care Coordination arrangement.

Practice workflow for CARC X 274

Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.

ApprovalHelp auto-drafts the appeal letter against the right federal appeal-rights regulation (ACA §2719, ERISA §503, NSA §2799A, 42 CFR 422 Subpart M, or 42 CFR 438 Subpart F) for the patient's plan type, the payer's own coverage policy, and the relevant clinical guideline. Drafts route to the clinician for signature in under five minutes.

CARC 274 group codes explained

On the 835 ERA, CARC 274 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.