CARC 198CO · Contractual Obligation
The service exceeded what was approved under the existing authorization, such as more visits or units than authorized.
- Common causes
- More units, visits, or days of service were provided than the original authorization covered.
- Suggested fix
- Request an extended or additional authorization for the excess units or visits, and submit an appeal with clinical justification if the services already occurred.
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 198 mean?
The service exceeded what was approved under the existing authorization, such as more visits or units than authorized.
How do I resolve CARC 198?
Request an extended or additional authorization for the excess units or visits, and submit an appeal with clinical justification if the services already occurred.
Why does CARC 198 happen?
More units, visits, or days of service were provided than the original authorization covered.
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.