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Denial Code 243

CARC 243: Services not authorized by network/primary care providers

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

240
The diagnosis is inconsistent with the patient's birth weight
241
Low Income Subsidy Co-payment Amount
242
Services not provided by network/primary care providers
245
Provider performance program withhold
246
This non-payable code is for required reporting only
247
Deductible for Professional service rendered in an Institutional setting and billed on an …

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