← Back to Code Directory
CARC
CO-261
CARC
CO — Contractual Obligation
Medical Necessity
Quick Facts
Code
CO-261
Type
CARC
Category
Medical Necessity
Status
Active
The procedure or service is inconsistent with the patient's history
What Does This Code Mean?
The billed service doesn’t align with the patient’s documented medical history on file with the payer.
Common Causes
- New diagnosis/procedure combination not previously seen for this patient
- History documentation not submitted with the claim
Recommended Next Steps
- Submit relevant history/documentation supporting the service
- Appeal if the service is clinically appropriate despite being new for this patient
Recently Viewed
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.