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CARC
CO-213
CARC
Authorization
Quick Facts
Code
CO-213
Type
CARC
Category
Authorization
Status
Active
What Does This Code Mean?
Non-compliance with the physician self referral prohibition legislation or payer policy.
Common Causes
- Authorization/referral not obtained before the service
- Authorization obtained but for different codes, units, or dates than billed
- Authorization expired before the service date
Recommended Next Steps
- Check the payer portal for an authorization on file and compare it exactly to what was billed
- Request a retroactive authorization if the payer allows it
- Appeal with clinical documentation if retro-authorization is denied
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Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.