CARC 199 Active

OA-199: Revenue Code and Procedure Code Mismatch

TL;DR

The code mismatch was flagged during COB. Correct per the specific payer's requirements and resubmit.

Action
Verify & Resubmit
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-199 Mean?

With OA (Other Adjustments), the revenue/procedure code mismatch was flagged during coordination of benefits. Different payers may have different revenue code requirements. Correct the code combination per the specific payer's guidelines and resubmit.

CARC 199 is a coding error specific to institutional (UB-04) claims where the revenue code and the CPT/HCPCS procedure code do not form a valid combination. Revenue codes categorize the type of service or department, while procedure codes identify the specific service performed. Payers validate these combinations and reject claims when the codes conflict.

This denial commonly results from data entry errors, outdated chargemaster entries, confusion between facility and professional billing requirements, or unbundling errors. The fix is straightforward — identify the correct revenue code for the procedure and resubmit.

Common Causes

Cause Frequency
Revenue code and procedure code mismatch in coordination of benefits When a secondary payer processes a claim, the revenue/procedure code combination flagged by the primary payer results in an OA adjustment Common
Payer-specific revenue code requirements differ Different payers may require different revenue codes for the same procedure, causing mismatches when standard combinations are used Common

How to Resolve

  1. Review payer-specific requirements Determine the specific payer's revenue code requirements for the procedure.
  2. Correct and resubmit Update the code combination and resubmit to the appropriate payer.
Do Not Appeal This Code

This is a billing/coding error where the revenue code does not match the procedure code. Correct the code combination and resubmit the claim rather than filing an appeal.

How to Prevent OA-199

Also Filed As

The same CARC 199 may appear with different Group Codes:

CO-199 PR-199

Related Denial Codes

OA-4 — Procedure Code Inconsistent with Modifier OA-5 — Procedure Code Inconsistent with Place of Service OA-6 — Procedure/Revenue Code Inconsistent with Patient Age OA-7 — Procedure/Revenue Code Inconsistent with Patient Gender OA-8 — Procedure Code Inconsistent with Provider Type/Specialty

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/199
  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://www.aapc.com/resources/claim-adjustment-reason-codes
  5. Codes maintained by X12. Visit x12.org for official definitions.