CARC 40CO · Contractual Obligation
The payer determined the service didn't meet the criteria for emergency or urgent care coverage rules.
- Common causes
- The diagnosis or presenting complaint didn't support an emergency-level visit under the payer's prudent-layperson or urgent care criteria.
- Suggested fix
- Submit clinical documentation supporting the urgency of the visit if warranted, or rebill under the appropriate non-emergent service type.
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 40 mean?
The payer determined the service didn't meet the criteria for emergency or urgent care coverage rules.
How do I resolve CARC 40?
Submit clinical documentation supporting the urgency of the visit if warranted, or rebill under the appropriate non-emergent service type.
Why does CARC 40 happen?
The diagnosis or presenting complaint didn't support an emergency-level visit under the payer's prudent-layperson or urgent care criteria.
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.