CARC 6
Procedure conflicts with the patient's age
The payer's edits say this procedure is not expected for a patient of this age.
Why you actually get this
- A date of birth keyed incorrectly at registration.
- An age-restricted code used outside its band.
- The service was genuinely appropriate but needs documentation to support the exception.
How to check whether it’s correct
- 01Verify the date of birth on the claim against the record.
- 02Confirm whether the code carries an age restriction for this payer.
Usually worth appealing
Where the date of birth is wrong, correct and resubmit. Where the service was clinically appropriate despite the age edit, the appeal needs documentation establishing why.
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.