US · guidance
CMS Pub. 100-04, ch. 18, § 20.8.2
Remittance Advice Messages
If the claim is denied because the beneficiary is under 35 years of age, the contractor shall use the
following remittance advice messages and associated codes when rejecting/denying claims under
this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario
Three.
CARC: 6
RARC: M37
Group Code: CO
If the claim is denied for a woman 35-39 because she has previously received this examination, the
contractor shall use the following remittance advice messages and associated codes when
rejecting/denying claims under this policy. This CARC/RARC combination is compliant with
CAQH CORE Business Scenario Three.
CARC: 119
RARC: M89
Group Code: CO
If the claim is denied for a woman age 40 and above because she has previously received this
examination within the past 12 months, the contractor shall use the following remittance advice
messages and associated codes when rejecting/denying claims under this policy. This
CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.
CARC: 119
RARC: M90
Group Code: CO
If the claim is denied because the provider that performed the screening is not certified to perform
the type of mammography billed (film or digital) the contractor shall use the following remittance
advice messages and associated codes when rejecting/denying claims under this policy. This
CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.
CARC: B7
RARC: N570
Group Code: CO
For claims that were submitted without the facility’s FDA-assigned certification number, the
contractor shall use the following remittance advice messages and associated codes when
rejecting/denying claims under this policy. This CARC/RARC combination is compliant with
CAQH CORE Business Scenario Two.
CARC: 16
RARC: MA128
Group Code: CO
For claims that were submitted with an invalid facility certification number, the contractor shall use
the following remittance advice messages and associated codes when rejecting/denying claims
under this policy. This CARC/RARC combination is compliant with CAQH CORE Business
Scenario Two.
CARC: 16
RARC: MA128
Group Code: CO
History
(Rev. 3961, Issued: 02-02- 18, Effective: 01-01- 18, Implementation: 07-02-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
4e8af47ce83e0053077313f505c9bfdfc25bf954d231526a8f488930a6574686
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