CARC 261CO · Contractual Obligation
The procedure or revenue code billed doesn't align with the patient's documented medical history.
- Common causes
- The service doesn't logically follow from prior diagnoses or procedures on file, such as a follow-up procedure billed without the corresponding initial service on record.
- Suggested fix
- Review the patient's claim history for consistency; correct the code or submit documentation clarifying the clinical context.
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 261 mean?
The procedure or revenue code billed doesn't align with the patient's documented medical history.
How do I resolve CARC 261?
Review the patient's claim history for consistency; correct the code or submit documentation clarifying the clinical context.
Why does CARC 261 happen?
The service doesn't logically follow from prior diagnoses or procedures on file, such as a follow-up procedure billed without the corresponding initial service on record.
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.