CARC 254CO · Contractual Obligation
The dental plan received this claim, but it's not a covered dental benefit and should be billed to the patient's medical plan instead.
- Common causes
- A procedure with both dental and medical billing pathways, such as certain oral surgery, was sent to the dental plan when medical coverage applies.
- Suggested fix
- Resubmit the claim to the patient's medical plan instead of the dental plan.
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 254 mean?
The dental plan received this claim, but it's not a covered dental benefit and should be billed to the patient's medical plan instead.
How do I resolve CARC 254?
Resubmit the claim to the patient's medical plan instead of the dental plan.
Why does CARC 254 happen?
A procedure with both dental and medical billing pathways, such as certain oral surgery, was sent to the dental plan when medical coverage applies.
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.