CARC 6: The procedure/revenue code is inconsistent with the modifier
A billing code modifier doesn't match the procedure code, causing the claim to be adjusted or denied.
What this means for your claim
Modifiers are two-digit add-ons to procedure codes that provide additional context. A mismatch between the procedure code and the modifier can result in a lower payment or denial.
What to do next
- 1
Ask your provider to review the modifier combination and resubmit with the correct modifier if there was a billing error.
- 2
Request an itemized bill and compare the procedure code and modifier to what your EOB shows.
- 3
If the modifier reflects something clinically accurate (e.g., bilateral procedure), ask the provider to appeal with supporting documentation.
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