CARC 198
Authorisation limit exceeded
An authorisation existed but the service went beyond the visits, units or window it covered.
Why you actually get this
- Treatment continued past the approved visit count.
- The service fell outside the approved date range.
- Units delivered exceeded those approved.
How to check whether it’s correct
- 01Compare delivered visits or units against what was approved.
- 02Confirm the date of service falls inside the authorised window.
- 03Establish whether an extension was requested before the limit was reached.
Sometimes worth appealing
Harder than a missing authorisation, because the payer did engage and set a limit. Where continued care was clinically necessary and documented, an extension request — even late — sometimes resolves it. The real fix is tracking authorisations against the schedule rather than filing them.
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.