CARC 274 Active

OA-274: Fee/Service Not Payable — Care Coordination Arrangement

TL;DR

OA-274 indicates the service is part of a bundled or global fee under the care coordination arrangement. Verify whether the service is separately billable before contesting.

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-274 Mean?

When paired with Group Code OA, the care coordination adjustment is typically related to a bundled payment or global fee arrangement. The service may be included in a larger bundled payment, so separate payment is not applicable. This adjustment is usually correct per the agreement terms.

CARC 274 indicates the payer denied or adjusted the claim because the billed service is not separately payable under the patient's care coordination arrangement. Care coordination arrangements include Accountable Care Organizations (ACOs), bundled payment programs, patient-centered medical homes, and other value-based care models that consolidate payment for multiple services.

Under these arrangements, some services are included in a global or bundled payment rather than being reimbursed individually. CARC 274 appears when the payer determines the billed service falls within the scope of the care coordination agreement and should not be billed separately.

The denial may also result from missing pre-authorization under the arrangement, exceeded frequency or quantity limits, the service not meeting the arrangement's medical necessity criteria, or coding errors that caused the claim to fall outside the arrangement's covered services when the service itself may be eligible.

Common Causes

Cause Frequency
Care coordination arrangement adjustment The service payment is adjusted as part of the care coordination arrangement terms without clear attribution to provider error or patient responsibility Most Common
Bundled payment arrangement The service is included in a bundled payment or global fee under the care coordination agreement, so separate payment is not applicable Common

How to Resolve

  1. Review the arrangement for bundled services Determine if the service is part of a bundled payment or global fee under the care coordination agreement.
  2. Contact the payer Confirm whether the adjustment is correct under the arrangement terms.
  3. Provide documentation if separately payable If the service falls outside the bundled arrangement, provide documentation showing it should be paid separately.
Do Not Appeal This Code

OA-274 indicates an adjustment under the care coordination arrangement that is typically correct per the agreement terms. Verify with the payer whether the service is separately billable rather than filing a formal appeal.

How to Prevent OA-274

Also Filed As

The same CARC 274 may appear with different Group Codes:

CO-274 PR-274

Related Denial Codes

OA-19 — Workers' Compensation Claim OA-20 — Liability Carrier Responsible OA-21 — No-Fault Carrier Responsible OA-22 — Coordination of Benefits - Another Payer May Cover OA-23 — Prior Payer Adjudication Impact

Sources

  1. https://www.mdclarity.com/denial-code/274
  2. https://x12.org/codes/claim-adjustment-reason-codes
  3. Codes maintained by X12. Visit x12.org for official definitions.