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Denial Code 172

CARC 172: Payment is adjusted when performed/billed by a provider of this specialty

This is a Claim Adjustment Reason Code (CARC). CARCs explain why a payer adjusted or denied a claim line and appear with a group code (CO, PR, OA, PI). Codes appear on the EOB / ERA after a claim is adjudicated.

Reference only — CARC/RARC are national code sets updated periodically. Verify against the current official list before acting on a denial or appeal.

Related CARC codes

169
Alternate benefit has been provided
170
Payment is denied when performed/billed by this type of provider
171
Payment is denied when performed/billed by this type of provider in this type of facility
173
Service/equipment was not prescribed by a physician
174
Service was not prescribed prior to delivery
175
Prescription is incomplete

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