CARC 59: Processed based on multiple or concurrent procedure rules
When multiple procedures are performed at the same time, the payment for secondary procedures is reduced.
What this means for your claim
Many insurers apply a 'multiple procedure reduction' — the highest-valued procedure is paid at 100%, and additional procedures are paid at a lower rate (e.g., 50%). This is normal but worth verifying.
What to do next
- 1
Confirm the reduction percentage aligns with your plan's multiple procedure rules in the Summary of Benefits.
- 2
Ask your provider if the correct procedures were ranked in order of value — the highest should be paid at full rate.
- 3
If a distinct procedure was reduced when it shouldn't have been (different site, separate session), ask the provider to appeal with documentation.
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