Official CARC description: “Non-covered charge(s).” Here’s what it actually means, why it fires, and how to get the claim paid.
The PR twin of CO 96: excluded service, patient owes. The compliance question is whether the patient was warned — and for Medicare, whether a valid ABN exists.
Liability group: PR = Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Check the exclusion against the actual plan document, not the EOB shorthand
Medicare: valid ABN on file? GA modifier billed? — that decides patient liability
No ABN where required: you may NOT bill the patient (CO 50-style medical-necessity cases)
Real exclusions with notice: statement with a plain-language explanation
Appeal mis-categorised exclusions (the plan covers it) exactly like CO 96. For Medicare, the ABN status — not the payer's grouping — determines whether the patient can be billed.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
Non-covered charge(s). In practice: The PR twin of CO 96: excluded service, patient owes. The compliance question is whether the patient was warned — and for Medicare, whether a valid ABN exists.
PR stands for Patient Responsibility — the amount can be billed to the patient (deductible, coinsurance, non-covered care) — but only after you verify the denial is correct. Mis-grouped PR denials are a common appeal win.
Appeal mis-categorised exclusions (the plan covers it) exactly like CO 96. For Medicare, the ABN status — not the payer's grouping — determines whether the patient can be billed.