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Denial Code P21

CARC P21: Payment denied based on the Medical Payments Coverage and/or Personal Injury Protection Benefits jurisdictional regulations, or payment policies

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

P18
Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a…
P19
Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no paym…
P20
Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used f…
P22
Payment adjusted based on the Medical Payments Coverage and/or Personal Injury Protection …
P23
Medical Payments Coverage or Personal Injury Protection Benefits jurisdictional fee schedu…
P24
Payment adjusted based on Preferred Provider Organization

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