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Denial Code A5

CARC A5: Medicare Claim PPS Capital Cost Outlier Amount

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

308
Payment is adjusted due to contracted funding agreement between the payer and provider
A0
Patient refund amount
A1
Claim/Service denied. Remark code required
A6
Prior hospitalization or 30 day transfer requirement not met
A8
Ungroupable DRG
B1
Non-covered visits

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