CARC 50: These are non-covered services because this is not deemed a 'medical necessity' by the payer
Your insurer decided this service wasn't medically necessary, so they won't pay for it.
What this means for your claim
Medical necessity denials are among the most common and most winnable appeals. Insurers must have a clinical basis for the denial, and you have the right to request their criteria and challenge the decision.
What to do next
- 1
Request the insurer's medical necessity criteria (InterQual or Milliman guidelines) used to make this determination.
- 2
Ask your treating physician to write a letter of medical necessity citing diagnosis, failed alternatives, and clinical urgency.
- 3
File a formal appeal with the physician's letter and any supporting clinical records. Consider requesting an expedited review if the service is time-sensitive.
Have more codes on your EOB?
Upload your full Explanation of Benefits and our analyzer will identify every adjustment code, explain each one in plain English, and flag anything worth disputing.
Analyze My EOB Free →