CARC 236 Active

OA-236: Procedure/Modifier Not Compatible per NCCI

TL;DR

The NCCI incompatibility was flagged during COB. Correct the modifier and resubmit.

Action
Verify & Resubmit
Who Pays
Depends
Appeal
Yes
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-236 Mean?

With OA, the NCCI edit was applied during coordination of benefits.

CARC 236 indicates that the modifier used with the procedure code is not recognized as valid by the NCCI Procedure-to-Procedure (PTP) edits. This differs from CARC 182 (modifier invalid on date of service) — CARC 236 specifically refers to NCCI compatibility rules between procedure codes and modifiers, not the modifier's validity dates.

The NCCI edits define which modifiers can be used with specific procedure code pairs to indicate separate and distinct services. Using an inappropriate modifier to bypass a bundling edit or applying a modifier that does not apply to the code pair will trigger this denial.

Common Causes

Cause Frequency
Informational NCCI edit adjustment The NCCI edit is reported as an OA informational adjustment Common

How to Resolve

  1. Review the NCCI edit Check the modifier compatibility.
  2. Resubmit Apply the correct modifier and resubmit.
Appeal Guide

Appeal with documentation supporting separate and distinct procedures and correct NCCI modifier usage.

How to Prevent OA-236

General Prevention

Also Filed As

The same CARC 236 may appear with different Group Codes:

CO-236 PR-236

Related Denial Codes

OA-59 — Multiple/Concurrent Procedure Rules Applied OA-60 — Outpatient Services Not Covered Near Inpatient Stay OA-97 — Bundled Service — Not Paid Separately OA-231 — Mutually Exclusive Procedures OA-234 — Procedure Not Paid Separately

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://imedclaims.com/co-236-denial-code/
  3. https://med.noridianmedicare.com/web/jfb/topics/claim-submission/reason-code-guidance/not-separately-payable-national-correct-coding-initiative
  4. Codes maintained by X12. Visit x12.org for official definitions.