CARC 49PR · Patient Responsibility

The service was denied because the plan doesn't cover routine or preventive exams, or this particular screening isn't included in the covered preventive benefit.

Common causes
The plan excludes routine physicals or screenings, or the service was billed as preventive when the plan only covers it diagnostically (or vice versa).
Suggested fix
Check whether the visit should have been billed with a diagnostic rather than preventive diagnosis, or confirm the plan's preventive benefit coverage with the patient.

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 49 mean?

The service was denied because the plan doesn't cover routine or preventive exams, or this particular screening isn't included in the covered preventive benefit.

How do I resolve CARC 49?

Check whether the visit should have been billed with a diagnostic rather than preventive diagnosis, or confirm the plan's preventive benefit coverage with the patient.

Why does CARC 49 happen?

The plan excludes routine physicals or screenings, or the service was billed as preventive when the plan only covers it diagnostically (or vice versa).

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.