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Denial Code 55

CARC 55: Procedure/treatment/drug is deemed experimental/investigational by the payer

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

51
These are non-covered services because this is a pre-existing condition
53
Services by an immediate relative or a member of the same household are not covered
54
Multiple physicians/assistants are not covered in this case
56
Procedure/treatment has not been deemed 'proven to be effective' by the payer
58
Treatment was deemed by the payer to have been rendered in an inappropriate or invalid pla…
59
Processed based on multiple or concurrent procedure rules

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