CARC B14 Active

CO-B14: Only One Visit/Consultation Per Physician Per Day Covered

TL;DR

CO-B14 means only one visit per physician per day is covered. Use modifier 25 for distinct encounters or consolidate into one visit.

Action

Resubmit

Who Pays

Provider

Appeal

Yes

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-B14 Mean?

When paired with Group Code CO, the one-visit-per-day limit is a contractual policy. The provider absorbs the denied visit and cannot collect it from the patient. Resubmit with modifier 25 if the visits were distinct.

CARC B14 indicates the payer denied a claim because only one visit or consultation per physician per day is covered under the plan. The provider billed for two or more evaluation and management services for the same physician and patient on the same date, and the payer only pays for one.

This rule prevents unbundling of a single encounter into multiple visits. However, there are legitimate situations where two separate encounters on the same day are appropriate — for example, when a patient returns for a new problem, or when a separately identifiable E/M service is performed alongside a procedure. In these cases, modifier 25 (Significant, Separately Identifiable Evaluation and Management Service) should be appended to the second E/M service.

If the second visit was a follow-up for the same condition seen earlier in the day, the services should be consolidated into a single encounter rather than billed as two separate visits.

Common Causes

Cause	Frequency
Multiple E/M services on same date The provider billed two or more evaluation and management (E/M) visits for the same physician and patient on the same date of service	Most Common
Same-day follow-up visit billed separately A follow-up visit on the same day was billed as a separate encounter instead of being included in the original visit	Most Common
Consultation and office visit on same date Both a consultation and an office visit were billed on the same date by the same physician	Common
Different specialties not distinguished Two visits by different specialties within the same group practice were billed under the same provider, triggering the one-visit limit	Common
Missing modifier 25 A separately identifiable E/M service was performed on the same day as a procedure but modifier 25 was not appended to distinguish it	Common

How to Resolve

Review same-day visits Compare the two visits for distinctness.
Apply modifier 25 if distinct Add modifier 25 to the separately identifiable E/M service and resubmit.
Appeal with records Submit records showing different chief complaints or diagnoses.
Consolidate if not distinct Combine into a single higher-level E/M visit.

Appeal Guide

Appeal with documentation showing the visits were separately identifiable services. Include medical records for both encounters demonstrating different chief complaints, different diagnoses, or a separate procedure requiring its own E/M visit. Apply modifier 25 to the separately identifiable E/M service.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-B14:

RARC	Description
M86	Service denied because payment already made for same/similar procedure within set time frame. Review same-day claims and apply modifier 25 if services were distinct →
N381	Alert: Consult your contractual agreement for restrictions, billing, and payment information. Check the payer's policy on same-day visit limits →

How to Prevent CO-B14

Implement scheduling rules to consolidate same-physician visits on the same day into a single encounter
Use modifier 25 when a separately identifiable E/M service is performed on the same day as a procedure
Ensure each provider's claims use the correct rendering provider NPI
Educate physicians on same-day billing limitations
Implement claim scrubbing edits that flag multiple same-day visits by the same physician

Also Filed As

The same CARC B14 may appear with different Group Codes:

PR-B14 OA-B14

Related Denial Codes

CO-269 — Anesthesia Not Covered for This Procedure CO-B16 — New Patient Qualifications Not Met CO-B13 — Previously Paid — Duplicate Payment CO-B20 — Service Partially or Fully Furnished by Another Provider CO-23 — Prior Payer Adjudication Impact

Sources

https://x12.org/codes/claim-adjustment-reason-codes
https://www.cms.gov/regulations-and-guidance/guidance/manuals
Codes maintained by X12. Visit x12.org for official definitions.