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B16 Denial Code — ‘New patient’ qualifications were not met – Denial Journal
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CARC

B16

CARC Coding/Modifier
Quick Facts
Code
B16
Type
CARC
Category
Coding/Modifier
Status
Active

'New patient' qualifications were not met

What Does This Code Mean?

A new-patient E/M code was billed, but the patient doesn’t meet the payer’s definition of a new patient (e.g. seen within the last 3 years).

Common Causes

  • Patient was actually seen by the same provider/group within the payer's look-back window
  • Wrong new-vs-established E/M code selected

Recommended Next Steps

  1. Verify the patient's visit history with this provider/group
  2. Correct to an established-patient code and resubmit if applicable

More Denial Codes to Check

CARC CO-B17 RARC MA100 RARC N76 RARC M77 RARC N58 CARC CO-10 CARC CO-P9 CARC CO-D1 RARC N26 RARC M47 RARC M128

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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