CARC 25 — The claim was denied because a stop-loss deductible threshold under the plan had

CARC 25PR · Patient ResponsibilityDeactivated 2008-04-01

The claim was denied because a stop-loss deductible threshold under the plan hadn't yet been reached.

Common causes: Used historically for stop-loss insurance arrangements, where a separate deductible applies before stop-loss coverage takes over.
Suggested fix: This code was deactivated by X12 in 2008. On legacy remittances, reconcile against the plan's stop-loss terms with the payer.

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 25 mean?

The claim was denied because a stop-loss deductible threshold under the plan hadn't yet been reached.

How do I resolve CARC 25?

This code was deactivated by X12 in 2008. On legacy remittances, reconcile against the plan's stop-loss terms with the payer.

Why does CARC 25 happen?

Used historically for stop-loss insurance arrangements, where a separate deductible applies before stop-loss coverage takes over.

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.