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Denial Code 261

CARC 261: The procedure or service is inconsistent with the patient's history

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

258
Claim/service not covered when patient is in custody/incarcerated. Applicable federal, sta…
259
Additional payment for Dental/Vision service utilization
260
Processed under Medicaid ACA Enhanced Fee Schedule
262
Adjustment for delivery cost
263
Adjustment for shipping cost
264
Adjustment for postage cost

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