CARC 188CO · Contractual Obligation
The payer only covers this product or procedure when it's used consistent with its FDA-approved indication, and this claim didn't meet that criteria.
- Common causes
- The product or drug was used off-label or outside the dosing or indication approved by the FDA.
- Suggested fix
- Confirm the usage matches FDA-approved labeling; if it was medically necessary off-label use, submit supporting literature and documentation on appeal.
Related Contractual Obligation codes
107This claim depends on another related claim or service being referenced, but that link wasn't provided.11The diagnosis code doesn't support medical necessity for the procedure billed, based on the payer's coverage edits.13The claim shows a date of service after the patient's recorded date of death.146The diagnosis code billed wasn't a valid, active code as of the date of service.150The documentation submitted doesn't justify the complexity or level of the service billed, commonly seen with evaluation and management visit levels.16The claim is missing required information or contains a billing error that prevented the payer from processing it.170This payer doesn't reimburse this specific provider type for this service.171This payer doesn't cover this service when it's billed by this provider type in this particular facility setting.
Frequently asked questions
What does CARC 188 mean?
The payer only covers this product or procedure when it's used consistent with its FDA-approved indication, and this claim didn't meet that criteria.
How do I resolve CARC 188?
Confirm the usage matches FDA-approved labeling; if it was medically necessary off-label use, submit supporting literature and documentation on appeal.
Why does CARC 188 happen?
The product or drug was used off-label or outside the dosing or indication approved by the FDA.
CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.