Deductible Amount
What Does CARC 1 Mean?
CARC 1 — "Deductible Amount" — is a Claim Adjustment Reason Code used by payers to indicate why a claim or service line was adjusted. This code falls under the Patient Responsibility category.
Common Causes
Here are the most common reasons this denial code appears on your remittance advice:
- Patient has not met their annual deductible for the plan year
- High-deductible health plan (HDHP) with significant out-of-pocket requirements
- Service rendered early in the plan year before deductible is satisfied
- Patient switched insurance plans mid-year with a new deductible
Is CARC 1 Appealable?
CARC 1 is generally not appealable. This code represents a patient responsibility adjustment (deductible, copay, or coinsurance). The appropriate action is to verify the amount with the payer and bill the patient.
Related RARC Codes
These Remittance Advice Remark Codes are commonly paired with CARC 1. The RARC tells you the specific reason for the adjustment.
Patient Billing Guidance
CARC 1 represents a patient responsibility amount. This is not a denial that can be appealed — the payer has correctly applied the patient's cost-sharing obligation under their benefit plan.
Recommended Steps:
- Verify the amount against the patient's Explanation of Benefits (EOB)
- Confirm the patient's deductible, copay, or coinsurance status with the payer
- Generate and send a patient responsibility statement
- Set up a payment plan if the amount is significant