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Denial Code 213

CARC 213: Non-compliance with the physician self referral prohibition legislation or payer policy

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

210
Payment adjusted because pre-certification/authorization not received in a timely fashion
211
National Drug Codes not eligible for rebate, are not covered
212
Administrative surcharges are not covered
215
Based on subrogation of a third party settlement
216
Based on the findings of a review organization or the payer's findings
219
Based on extent of injury

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