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CARC
CO-55
CARC
CO — Contractual Obligation
Medical Necessity
Quick Facts
Code
CO-55
Type
CARC
Category
Medical Necessity
Status
Active
Procedure/treatment/drug deemed experimental/investigational by the payer
What Does This Code Mean?
The payer classifies this treatment as experimental or investigational and therefore not covered.
Common Causes
- Newer treatment/drug not yet added to payer's covered services list
- Off-label use of an approved drug
Recommended Next Steps
- Review the payer's medical policy on the specific treatment
- Submit clinical literature/documentation supporting standard-of-care use if applicable
- Discuss patient financial responsibility in advance for known experimental treatments
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Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.