CARC 205 Active

OA-205: Pharmacy Discount Card Processing Fee

TL;DR

This is an informational adjustment for the processing fee. No action required beyond record-keeping.

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-205 Mean?

With OA (Other Adjustments), the processing fee appears as an informational adjustment. This is a reporting notation and does not directly affect the pharmacy's payment beyond what is already reflected in the CO adjustment.

CARC 205 represents a per-transaction processing fee that is deducted from the pharmacy's payment when a claim is processed through a pharmacy discount card program. This is not a denial — it is a contractual fee reduction that the pharmacy agreed to when enrolling in the discount card program.

Pharmacy discount cards (such as GoodRx, SingleCare, or payer-specific discount programs) provide patients with reduced drug prices, but pharmacies pay a processing fee for each transaction. This fee is deducted from the pharmacy's reimbursement on each claim. The amount is determined by the pharmacy's contract with the discount card processor.

Common Causes

Cause Frequency
Informational adjustment for discount card processing The payer reports the discount card processing fee as an informational adjustment that does not affect the provider's payment directly Common

How to Resolve

  1. Record the adjustment Log the informational adjustment for accounting purposes.
Do Not Appeal This Code

This is an informational adjustment for reporting purposes. It reflects the pharmacy discount card processing fee and does not require an appeal.

How to Prevent OA-205

Also Filed As

The same CARC 205 may appear with different Group Codes:

CO-205 PR-205

Related Denial Codes

OA-24 — Charges Covered Under Capitation/Managed Care OA-44 — Prompt-Pay Discount OA-45 — Charge Exceeds Fee Schedule/Maximum Allowable OA-69 — Day Outlier Amount OA-70 — Cost Outlier Adjustment

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/205
  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. Codes maintained by X12. Visit x12.org for official definitions.