96: Non-covered charge(s).
The service billed is simply not a covered benefit under this plan. Code 96 is a broad, generic non-coverage flag and is almost always paired with a remark code that explains the specific reason, such as a benefit exclusion, non-covered item, or missing modifier.
What the group code means
- PR
- Patient Responsibility. The amount may be billed to the patient.
- CO
- Contractual Obligation. The provider is responsible and the amount cannot be billed to the patient.
This CARC is reported under more than one group code depending on the payer and the circumstances: PR, CO.
Why it fires
- The billed item or service is excluded from the plan's benefit design
- A required modifier or code combination that would make it covered was missing
- The remark code paired with 96 points to a specific reason such as cosmetic, experimental, or not medically necessary
Corrective actions, ranked
- 1
Read the paired remark code first
Code 96 alone is not actionable. The remark code tells you the real reason for non-coverage.
- 2
Verify the benefit
Check the patient's plan documents to confirm whether the service is genuinely excluded or if the claim was coded in a way that triggered a false exclusion.
- 3
Correct and resubmit or bill the patient
If it is a coding issue, fix and resubmit. If it is a true exclusion, move the balance to patient responsibility per the payer contract.
Is it worth appealing
Appeal only when the remark code paired with 96 indicates a fixable issue, such as a wrong code or missing modifier, rather than a genuine plan exclusion.
Related remark codes
Retrieved 2026-07-18.
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DenialPath provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.