CARC 239PR · Patient Responsibility
This is the specific reduced payment amount for the portion of a claim that falls in the patient's ineligible coverage period.
- Common causes
- Same as code 238: a coverage change occurred mid-stay or mid-service-period, and this line isolates the ineligible-period amount.
- Suggested fix
- Bill the patient, or applicable secondary coverage, for this ineligible-period amount; confirm the coverage change date is accurate.
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 239 mean?
This is the specific reduced payment amount for the portion of a claim that falls in the patient's ineligible coverage period.
How do I resolve CARC 239?
Bill the patient, or applicable secondary coverage, for this ineligible-period amount; confirm the coverage change date is accurate.
Why does CARC 239 happen?
Same as code 238: a coverage change occurred mid-stay or mid-service-period, and this line isolates the ineligible-period amount.
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.