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Denial Code 204

CARC 204: This service/equipment/drug is not covered under the patient's current benefit plan

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

201
Patient is responsible for amount of this claim/service through 'set aside arrangement' or…
202
Non-covered personal comfort or convenience services
203
Discontinued or reduced service
205
Pharmacy discount card processing fee
206
NPI - missing
207
NPI - Invalid format

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