CARC 194 — Payment was adjusted because the anesthesia was administered by the same physic

CARC 194CO · Contractual Obligation

Payment was adjusted because the anesthesia was administered by the same physician who performed or assisted with the surgery, which payers typically reimburse differently.

Common causes: Self-administered or surgeon-administered anesthesia, such as local anesthesia by the surgeon, is often bundled into the surgical payment rather than paid separately.
Suggested fix: Confirm payer policy on self-administered anesthesia billing; if separate payment isn't allowed, no further action is needed.

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 194 mean?

Payment was adjusted because the anesthesia was administered by the same physician who performed or assisted with the surgery, which payers typically reimburse differently.

How do I resolve CARC 194?

Confirm payer policy on self-administered anesthesia billing; if separate payment isn't allowed, no further action is needed.

Why does CARC 194 happen?

Self-administered or surgeon-administered anesthesia, such as local anesthesia by the surgeon, is often bundled into the surgical payment rather than paid separately.

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.