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CARC 50Medical Necessity Appealable

These are non-covered services because this is not deemed a 'medical necessity' by the payer

Quick Action: Gather clinical documentation and payer LCD/NCD, then file a medical necessity appeal.
Typically seen with:CO — Contractual ObligationOA — Other Adjustment
~55.00%
Estimated appeal win rate for CARC 50 denials

What Does CARC 50 Mean?

CARC 50 — "These are non-covered services because this is not deemed a 'medical necessity' by the payer" — is a Claim Adjustment Reason Code used by payers to indicate why a claim or service line was adjusted. This code falls under the Medical Necessity category.

Common Causes

Here are the most common reasons this denial code appears on your remittance advice:

  • Clinical documentation doesn't support medical necessity for the service
  • Diagnosis code doesn't meet the payer's Local/National Coverage Determination (LCD/NCD)
  • Service frequency exceeds what the payer deems medically necessary
  • Prior authorization was required but not obtained
  • Payer's utilization management determined the service was not needed

Is CARC 50 Appealable?

Yes, CARC 50 is appealable. With proper documentation and a well-crafted appeal, this denial code has an estimated win rate of approximately 55.00%. Success depends on the quality of your documentation and the specifics of the denial.

How to Appeal CARC 50

Follow these steps to maximize your chances of a successful appeal:

1 Pull complete clinical documentation showing why the service was medically necessary
2 Check the payer's LCD/NCD for the specific diagnosis-procedure pairing
3 Write a detailed appeal letter citing clinical evidence and medical literature
4 Include peer-reviewed studies supporting the medical necessity of the service
5 Consider a peer-to-peer review with the payer's medical director

Related RARC Codes

These Remittance Advice Remark Codes are commonly paired with CARC 50. The RARC tells you the specific reason for the adjustment.

M25 The information furnished does not substantiate the need for this level of service
M26 The information furnished does not substantiate the need for this level of service - refund requirements
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable
N386 This decision was based on a National Coverage Determination (NCD)

Appeal Letter Template

.DOCX

Customize the fields below to generate a ready-to-send appeal letter for CARC 50. Downloads as a formatted Word document.

Letter Body (editable)

Letter Preview

This is how your letter will look when downloaded

March 26, 2026

[Payer Name]

[Payer Address]

RE: Appeal for Claim #[Claim Number]
Patient: [Patient Name] | Member ID: [Member ID]
Date of Service: [Date of Service] | Denied Amount: $[Denied Amount]

Dear Claims Review Department,

I am writing to formally appeal the denial of the above-referenced claim, denied with CARC 50: "These are non-covered services because this is not deemed a 'medical necessity' by the payer".

Our appeal is based on the following:

  • Pull complete clinical documentation showing why the service was medically necessary
  • Check the payer's LCD/NCD for the specific diagnosis-procedure pairing
  • Write a detailed appeal letter citing clinical evidence and medical literature
  • Include peer-reviewed studies supporting the medical necessity of the service
  • Consider a peer-to-peer review with the payer's medical director

We have reviewed the common reasons for this denial and can confirm that the following do not apply to this claim:

  • Clinical documentation doesn't support medical necessity for the service
  • Diagnosis code doesn't meet the payer's Local/National Coverage Determination (LCD/NCD)
  • Service frequency exceeds what the payer deems medically necessary
  • Prior authorization was required but not obtained
  • Payer's utilization management determined the service was not needed

Recommended action: Gather clinical documentation and payer LCD/NCD, then file a medical necessity appeal.

Enclosed please find supporting documentation for your review. We respectfully request reconsideration and payment of $[Denied Amount].

Sincerely,

[Provider Name]

[NPI] | [Phone]

[Practice/Organization Name]

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