CARC 151
Too many services for the payer's liking
The payer considers the frequency or quantity billed unsupported by what was submitted.
Why you actually get this
- Units billed exceed what the payer expects for the service.
- Repeat services within a period exceeded a frequency limit.
- Documentation submitted did not establish why the frequency was necessary.
How to check whether it’s correct
- 01Confirm the units billed match what was delivered and documented.
- 02Check the payer's frequency limit for this service and period.
- 03Establish whether the documentation explains the clinical need for the frequency.
Sometimes worth appealing
Where the frequency was clinically justified and documented, appeal with the record. Where a hard frequency limit was exceeded, the appeal rarely succeeds and the question becomes whether the patient was informed in advance.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.