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Denial Code 56

CARC 56: Procedure/treatment has not been deemed 'proven to be effective' 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

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
55
Procedure/treatment/drug is deemed experimental/investigational 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
60
Charges for outpatient services are not covered when performed within a period of time pri…

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