CARC 96PR · Patient Responsibility
This service or charge isn't covered under the patient's benefit plan.
- Common causes
- The service is explicitly excluded from the plan's benefits, or an accompanying remark code specifies the exact reason, such as it not being covered when performed by this provider type.
- Suggested fix
- Check the accompanying remark code for the specific exclusion reason; if the plan genuinely excludes it, bill the patient after confirming they understand their financial responsibility.
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 96 mean?
This service or charge isn't covered under the patient's benefit plan.
How do I resolve CARC 96?
Check the accompanying remark code for the specific exclusion reason; if the plan genuinely excludes it, bill the patient after confirming they understand their financial responsibility.
Why does CARC 96 happen?
The service is explicitly excluded from the plan's benefits, or an accompanying remark code specifies the exact reason, such as it not being covered when performed by this provider type.
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.