CARC 213CO · Contractual Obligation
The claim violates physician self-referral rules, such as the Stark Law, or the payer's related policy.
- Common causes
- The referring physician has a financial relationship with the entity performing the service, which self-referral laws restrict.
- Suggested fix
- Review the referral relationship for self-referral and anti-kickback compliance; this typically requires legal or compliance review rather than a simple resubmission.
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 213 mean?
The claim violates physician self-referral rules, such as the Stark Law, or the payer's related policy.
How do I resolve CARC 213?
Review the referral relationship for self-referral and anti-kickback compliance; this typically requires legal or compliance review rather than a simple resubmission.
Why does CARC 213 happen?
The referring physician has a financial relationship with the entity performing the service, which self-referral laws restrict.
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.