US · guidance
CMS Pub. 100-04, ch. 13, § 20.2.5.1
Remittance Advice Remark Codes (RARCs), Claim Adjustment Reason
Codes (CARCs), and Medicare Summary Notice (MSN)
(Rev.3820, Issued: 11-21-17, Effective: 01-01-18, Implementation; 01-02-18)
Contractors shall use the following messages when adjusting x-ray radiograph claim lines that have been
reported with the FX modifier:
CARC 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be
comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an
ALERT.)
RARC N775 - Payment adjusted based on x-ray radiograph on film.
MSN 30.1 - The approved amount is based on a special payment method.
History
(Rev.3820, Issued: 11-21-17, Effective: 01-01-18, Implementation; 01-02-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
b137dcceb1097464b02c074155e515ae0e0f9feedd09c3871838b717bd48c3dc
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