CARC 194 Active

OA-194: Anesthesia by Operating/Assistant/Attending Physician

TL;DR

The anesthesia billing issue was flagged during coordination of benefits. Correct and resubmit.

Action
Review & Decide
Who Pays
Depends
Appeal
No
Patient Impact
Indirect
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 OA-194 Mean?

With OA (Other Adjustments), the anesthesia billing issue was flagged during coordination of benefits. Correct the provider information and modifiers and resubmit through the proper COB sequence.

CARC 194 indicates that anesthesia services were billed separately but the payer determined they were performed by the operating physician, assistant surgeon, or attending physician rather than a dedicated anesthesia provider (anesthesiologist or CRNA). Most payers consider anesthesia by the surgeon to be included in the surgical payment and do not pay for it separately.

This code commonly appears when anesthesia claims are submitted without proper provider identification or modifiers to distinguish who administered the anesthesia. If a separate anesthesia provider (anesthesiologist or CRNA) actually performed the anesthesia, the claim needs to be corrected with the appropriate provider information and modifiers.

How to Resolve

  1. Verify the anesthesia provider Confirm who performed the anesthesia.
  2. Correct and resubmit Fix provider information and modifiers, then resubmit through the COB sequence.
Do Not Appeal This Code

Anesthesia by Operating/Assistant/Attending Physician grouped under OA is an Other Adjustment that doesn't fall into the standard contractual write-off or patient responsibility categories. Whether action is needed depends on the specific reason — review any accompanying RARC codes and payer guidance to decide whether this is a final adjustment to accept or an issue to resolve through resubmission.

How to Prevent OA-194

Also Filed As

The same CARC 194 may appear with different Group Codes:

CO-194 PR-194

Related Denial Codes

OA-74 — Indirect Medical Education Adjustment OA-75 — Direct Medical Education Adjustment OA-76 — Disproportionate Share Adjustment OA-85 — Patient Interest Adjustment OA-89 — Professional Fees Removed from Charges

Sources

  1. https://www.mdclarity.com/denial-code-carcs
  2. https://x12.org/codes/claim-adjustment-reason-codes
  3. 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
  4. https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/ClaimDenialCodes.pdf
  5. Codes maintained by X12. Visit x12.org for official definitions.