CARC 241 Active

OA-241: Low Income Subsidy (LIS) Co-payment Amount

TL;DR

The LIS amount is reported as an informational adjustment. No action needed 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-241 Mean?

With OA, the LIS amount appears as an informational adjustment during coordination of benefits or reporting.

CARC 241 indicates the co-payment amount assigned to a Medicare Part D beneficiary who qualifies for the Low Income Subsidy (LIS), also known as Extra Help. LIS beneficiaries receive reduced cost-sharing on their prescription drugs — their co-payments are significantly lower than standard Part D co-payments, typically ranging from $0 to a few dollars per prescription.

This code is not a denial — it is an informational adjustment showing the small co-payment amount the patient owes. The LIS program is designed to help low-income Medicare beneficiaries afford their medications, and the co-payment amounts are set by CMS annually.

Common Causes

Cause Frequency
LIS copayment reporting as informational adjustment The LIS copayment amount is reported as an OA informational adjustment for tracking purposes Common

How to Resolve

  1. Record the adjustment Log the LIS co-payment for accounting purposes.
Do Not Appeal This Code

This is an informational adjustment reporting the LIS copayment amount. No appeal is needed.

How to Prevent OA-241

General Prevention

Also Filed As

The same CARC 241 may appear with different Group Codes:

PR-241 CO-241

Related Denial Codes

OA-1 — Deductible Amount OA-2 — Coinsurance Amount OA-3 — Co-payment Amount OA-66 — Blood Deductible OA-247 — Deductible for Professional Service in Institutional Setting

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. 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
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.