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CARC 96Non-Covered Appealable

Non-covered charge(s)

Quick Action: Review the patient's benefit plan; if covered, appeal with plan documentation.
Typically seen with:CO — Contractual ObligationPR — Patient Responsibility
~35.00%
Estimated appeal win rate for CARC 96 denials

What Does CARC 96 Mean?

CARC 96 — "Non-covered charge(s)" — is a Claim Adjustment Reason Code used by payers to indicate why a claim or service line was adjusted. This code falls under the Non-Covered category.

Common Causes

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

  • Service is explicitly excluded from the patient's benefit plan
  • Experimental or investigational procedure not covered
  • Service exceeds plan benefit limits
  • Cosmetic procedure billed as medically necessary
  • Service type not included in the patient's coverage tier

Is CARC 96 Appealable?

Yes, CARC 96 is appealable. With proper documentation and a well-crafted appeal, this denial code has an estimated win rate of approximately 35.00%. While the win rate is moderate, strong clinical documentation can significantly improve your chances.

How to Appeal CARC 96

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

1 Review the patient's benefit plan to verify coverage exclusions
2 If the service should be covered, obtain a copy of the plan document and appeal
3 For experimental services, provide evidence of FDA approval or clinical trial data
4 Document the medical necessity to distinguish from cosmetic/elective services
5 Consider an external review if the internal appeal is denied

Related RARC Codes

These Remittance Advice Remark Codes are commonly paired with CARC 96. The RARC tells you the specific reason for the adjustment.

MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable
N30 Patient ineligible for this service
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 96. Downloads as a formatted Word document.

Letter Body (editable)

Letter Preview

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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 96: "Non-covered charge(s)".

Our appeal is based on the following:

  • Review the patient's benefit plan to verify coverage exclusions
  • If the service should be covered, obtain a copy of the plan document and appeal
  • For experimental services, provide evidence of FDA approval or clinical trial data
  • Document the medical necessity to distinguish from cosmetic/elective services
  • Consider an external review if the internal appeal is denied

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

  • Service is explicitly excluded from the patient's benefit plan
  • Experimental or investigational procedure not covered
  • Service exceeds plan benefit limits
  • Cosmetic procedure billed as medically necessary
  • Service type not included in the patient's coverage tier

Recommended action: Review the patient's benefit plan; if covered, appeal with plan documentation.

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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