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Denial Code 95

CARC 95: Plan procedures not followed

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

90
Ingredient cost adjustment
91
Dispensing fee adjustment
94
Processed in Excess of charges
96
Non-covered charge(s). Remark code required
97
The benefit for this service is included in the payment/allowance for another service/proc…
100
Payment made to patient/insured

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