CARC 247 Active

CO-247: Deductible for Professional Service in Institutional Setting

TL;DR

The patient owes a deductible for a professional service rendered in an institutional setting under a Medicare bundled payment program. Verify the deductible amount is correct and collect from the patient.

Action
Review & Decide
Who Pays
Provider
Appeal
No
Patient Impact
None
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does CO-247 Mean?

CARC 247 identifies the patient's deductible obligation for a professional service that was provided in an institutional setting and billed on an institutional claim. This code is specific to Medicare bundled payment programs established under the Affordable Care Act (PPACA), such as the Bundled Payments for Care Improvement (BPCI) initiative.

In a bundled payment arrangement, Medicare makes a single payment covering all services during an episode of care. When a professional service (such as a physician's evaluation or procedure) is performed within an institutional setting and billed on the facility's claim, the patient's deductible still applies. CARC 247 isolates this deductible amount so the provider knows exactly how much to collect from the patient for the professional component.

This code appears only in the context of Medicare bundled payment programs. The deductible amount follows the standard Medicare Part A or Part B deductible rules, depending on the service type within the bundled episode.

How to Resolve

Verify the deductible amount and collect from the patient. Contact the Medicare contractor if the amount appears incorrect.

  1. Verify the patient's deductible status Check the patient's Medicare deductible accumulation to confirm the applied amount is correct for the date of service.
  2. Confirm bundled payment episode Verify the claim is part of a Medicare bundled payment episode and that CARC 247 is the appropriate deductible code for this context.
  3. Send the patient a statement Issue a patient statement for the deductible amount. Include the date of service, description of the professional service, and the deductible applied.
  4. Contact Medicare if amount appears incorrect If the deductible amount does not match your records of the patient's deductible accumulation, contact the Medicare Administrative Contractor for clarification.
Do Not Appeal This Code

Deductible for Professional Service in Institutional Setting represents an amount the patient owes per their plan benefits — usually a deductible, coinsurance, or copay calculated against plan terms. Since the calculation comes from the benefits rather than a coverage denial, appeals don't apply. Verify the calculation against the patient's plan and collect the patient portion.

Also Filed As

The same CARC 247 may appear with different Group Codes:

PR-247 OA-247

Related Denial Codes

CO-1 — Deductible Amount CO-2 — Coinsurance Amount CO-66 — Blood Deductible CO-248 — Coinsurance for Professional Service in Institutional Setting CO-281 — Deductible Waived Per Contractual Agreement

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.