CMS Pub. 100-04, ch. 18, § 150.3

Claims Adjustment Reason Codes (CARCs), and Group Codes

(Rev. 13549; Issued: 12-18-25; Effective: 01-20-26; Implementation: 01-20-26)

When denying claims for counseling to prevent tobacco use services submitted without ICD-

10-CM is applicable, one of the following diagnosis codes:

ICD-10

CM Code

Code Description

F17.210 Nicotine dependence, cigarettes, uncomplicated

F17.211 Nicotine dependence, cigarettes, in remission

F17.213 Nicotine dependence, cigarettes, with withdrawal

F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders

F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

F17.220 Nicotine dependence, chewing tobacco, uncomplicated

F17.221 Nicotine dependence, chewing tobacco, in remission

F17.223 Nicotine dependence, chewing tobacco, with withdrawal

F17.228 Nicotine dependence, chewing tobacco, with other nicotine-induced disorders

F17.229 Nicotine dependence, chewing tobacco, with unspecified nicotine-induced

disorders

F17.290 Nicotine dependence, other tobacco product, uncomplicated

F17.291 Nicotine dependence, other tobacco product, in remission

F17.293 Nicotine dependence, other tobacco product, with withdrawal

F17.298 Nicotine dependence, other tobacco product, with other nicotine-induced disorders

F17.299 Nicotine dependence, other tobacco product, with unspecified nicotine-induced

disorders

T65.211A Toxic effect of chewing tobacco, accidental (unintentional), initial encounter

T65.212A Toxic effect of chewing tobacco, intentional self-harm, initial encounter

T65.213A Toxic effect of chewing tobacco, assault, initial encounter

T65.214A Toxic effect of chewing tobacco, undetermined, initial encounter

T65.221A Toxic effect of tobacco cigarettes, accidental (unintentional), initial encounter

T65.222A Toxic effect of tobacco cigarettes, intentional self-harm, initial encounter

T65.223A Toxic effect of tobacco cigarettes, assault, initial encounter

T65.224A Toxic effect of tobacco cigarettes, undetermined, initial encounter

T65.291A Toxic effect of other tobacco and nicotine, accidental (unintentional), initial

encounter

T65.292A Toxic effect of other tobacco and nicotine, intentional self-harm, initial encounter

T65.293A Toxic effect of other tobacco and nicotine, assault, initial encounter

T65.294A Toxic effect of other tobacco and nicotine, undetermined, initial encounter

Z72.0 Tobacco use effective October 1, 2024

Z87.891 Personal history of nicotine dependence

or without above ICD-10-CM is applicable Part A/B MACs (A), (B), or (HHH) shall use the

following messages:

CARC 16 – “Claim/service lacks information or has submission/billing error(s).”

RARC M64 - “Missing/incomplete/invalid other diagnosis”

A/B MACs (A), (B), or (HHH) shall use Group Code CO, assigning financial liability to the

provider, if a claim is received with no signed ABN on file.

MSN 15.4: The information provided does not support the need for this service or item.

MSN Spanish Version: La información proporcionada no confirma la necesidad para este

servicio o artículo

When denying claims for counseling to prevent tobacco use services and smoking and

tobacco-use cessation counseling services that exceed a combined total of 8 sessions within

a 12-month period (99406, 99407), A/B MACs (A), (B), or (HHH) shall use the following

messages:

CARC 119: “Benefit maximum for this time period or occurrence has been reached.”

RARC N362: “The number of days or units of service exceeds our acceptable maximum.”

A/B MACs (A), (B), or (HHH) shall use Group Code PR, assigning financial liability to the

beneficiary, if a claim is received with a signed ABN on file.

A/B MACs (A), (B), or (HHH) shall use Group Code CO, assigning financial liability to the

provider, if a claim is received with no signed ABN on file.

MSN 20.5: “These services cannot be paid because your benefits are exhausted at this

time.”

MSN Spanish Version: “Estos servicios no pueden ser pagados porque sus beneficios

se han agotado.