CARC 238 — The billed service period includes both dates when the patient was covered and

CARC 238PR · Patient Responsibility

The billed service period includes both dates when the patient was covered and dates when they weren't.

Common causes: A long inpatient stay or ongoing service crosses a coverage change, such as a plan termination or new enrollment mid-stay.
Suggested fix: Split the billed charges by eligible and ineligible date ranges and resubmit accordingly, or bill the patient for the ineligible portion.

Related Patient Responsibility codes

1The billed amount was applied to the patient's plan deductible instead of being paid by the payer.119The patient has used up the maximum benefit allowed for this service within the applicable time period, such as an annual visit limit.167The specific diagnosis code(s) on this claim aren't covered under the patient's plan.177The patient doesn't currently meet the plan's eligibility criteria for this benefit.187This amount was or should be paid from the patient's consumer-directed spending account, such as an HSA or FSA, rather than by the payer.2This portion of the claim represents the patient's coinsurance share, the percentage of the allowed amount they are responsible for under their plan.200The service date falls within a period when the patient's coverage had lapsed.201The patient is responsible for this amount under a legal set-aside arrangement, commonly seen in workers' compensation Medicare Set-Aside cases, rather than the payer.

Frequently asked questions

What does CARC 238 mean?

The billed service period includes both dates when the patient was covered and dates when they weren't.

How do I resolve CARC 238?

Split the billed charges by eligible and ineligible date ranges and resubmit accordingly, or bill the patient for the ineligible portion.

Why does CARC 238 happen?

A long inpatient stay or ongoing service crosses a coverage change, such as a plan termination or new enrollment mid-stay.

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.