OA-155: Patient Refused the Service/Procedure

What Does OA-155 Mean?

OA-155 is the standard pairing for this code. The OA designation classifies this as a general adjustment — the denial is due to the patient's refusal, which is an administrative situation that does not fit standard contractual obligation or patient responsibility categories. If the service was not rendered, there is no financial responsibility to assign — the claim simply should not have been submitted. Write off the amount and focus on preventing this from happening again.

CARC 155 appears on your remittance when the payer has denied the claim because the patient refused to receive the service or procedure that was billed. This is a fundamentally different type of denial — it is not about coverage, coding, or medical necessity. It is about whether the service was actually rendered.

The most common reason you see CARC 155 is a billing workflow breakdown: the service was scheduled and queued for billing, but the patient declined it before or during the encounter, and the claim was submitted anyway. This happens when clinical staff does not communicate the refusal to billing, or when automated billing systems generate claims for scheduled services without verifying they were completed. The second scenario is that the payer has information (from the patient or another source) indicating the patient refused the service, even though the provider's records show it was delivered.

This denial almost always appears with the OA group code, designating it as a general adjustment outside standard contractual or patient responsibility frameworks. If the patient genuinely refused the service, there is nothing to appeal — you cannot bill for a service that was not rendered. The correct action is to write off the claim and update the patient's records. If the service was actually performed despite the payer's assertion, you need to resubmit with clinical documentation proving the service was rendered, including treatment notes, patient signatures, and any consent forms.

Common Causes

How to Resolve

Confirm whether the service was rendered or refused, then either write off the claim or resubmit with proof the service was actually performed.

1. Confirm the service was not rendered Verify with the clinical team that the patient declined the service and that it was not performed.
2. Document and write off Ensure the refusal is documented in the patient's record and write off the claim amount.
3. Prevent future billing errors Implement a workflow that flags services the patient has refused and prevents those services from generating claims automatically.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-155:

How to Prevent OA-155

• Implement EHR flags that mark services as refused and prevent automatic claim generation for those services
• Establish a clear communication process between clinical and billing staff for patient refusals
• Train staff to document patient refusals immediately in the medical record and flag them in the billing system
• Verify that all scheduled services were actually rendered before submitting claims

General Prevention

• Implement a clear documentation process for patient refusals that includes the date, reason for refusal, and a notation that the service was not rendered
• Train clinical staff to communicate effectively about the necessity, benefits, and risks of recommended services to reduce patient refusals
• Establish a workflow that prevents claims from being submitted for services that were scheduled but not rendered due to patient refusal
• Provide patients with cost estimates before service delivery so cost-related refusals can be identified and addressed before the service is scheduled
• Document informed consent conversations in the medical record to demonstrate that the patient was fully informed before making their decision

Also Filed As

The same CARC 155 may appear with different Group Codes:

Related Denial Codes