OA-89: Professional Fees Removed from Charges

What Does OA-89 Mean?

When paired with Group Code OA, CARC 89 (Professional Fees Removed from Charges) is processed as an adjustment outside the standard CO/PR classifications. This typically occurs in secondary payer or coordination of benefits scenarios. Review the remittance details and the COB arrangement to determine financial responsibility and appropriate next steps.

CARC 89 indicates professional fees removed from charges. The payer's adjudication logic determined that this service or procedure is included within another service that was billed on the same claim or a related claim.

Common scenarios that trigger this adjustment include: the facility included professional fees (physician services) on the institutional claim instead of billing them separately on a CMS-1500 or 837P. The payer removes the professional component and adjusts the payment accordingly; The claim was submitted with a bill type that includes both professional and technical components, but the payer's policy requires separate billing for the professional component; The claim was missing modifier 26 (professional component) or TC (technical component) to properly distinguish between the two, causing the payer to strip out the professional fees. The group code paired with CARC 89 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

How to Resolve

1. Review the coordination of benefits Examine the OA-89 adjustment to understand how it fits within the primary/secondary payer relationship or other multi-payer context.
2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
3. Determine the responsible party Based on the COB review, identify whether the adjustment should be absorbed, billed to another payer, or if additional documentation is needed.
4. Appeal or resubmit if needed If the OA adjustment appears incorrect based on the COB arrangement, submit an appeal or corrected claim with the appropriate documentation.
5. Follow up Monitor the claim status and take additional action as needed based on the COB determination.

How to Prevent OA-89

• Maintain accurate coordination of benefits information
• Verify secondary payer requirements before claim submission

Also Filed As

The same CARC 89 may appear with different Group Codes:

Related Denial Codes