CMS Pub. 100-04, ch. 32, § 200.5

Code (RARC) and Claim Adjustment Reason Code (CARC) Messages

(Rev.11035, Issued:10-13-21, Effective: 11-17-21; Implementation: 11-17-21)

The following messages are used by Medicare contractors when denying non- covered VNS

services:

MSN: 16.10 “Medicare does not pay for this item or service."

CARC: 50 “These are non-covered services because this is not deemed a “medical

necessity” by the payer."

The following RARC messages can be used depending on liability:

M27 Alert: The patient has been relieved of liability of payment of these items and services

under the limitation of liability provision of the law. You, the provider, are ultimately liable for

the patient's waived charges, including any charges for coinsurance, since the items or services

were not reasonable and necessary or constituted custodial care, and you knew or could

reasonably have been expected to know, that they were not covered. You may appeal this

determination. You may ask for an appeal regarding both the coverage determination and the

issue of whether you exercised due care. The appeal request must be filed within 120 days of the

date you receive this notice. You must make the request through this office.

Or

M38 Alert: The patient is liable for the charges for this service as you informed the patient in

writing before the service was furnished that we would not pay for it, and the patient agreed to

pay.

Contractors will also include group code CO (contractual obligation) or PR (patient

responsibility) depending on liability.