CARC 89 Active

OA-89: Professional Fees Removed from Charges

TL;DR

Professional fee balance is flagged for the secondary payer. Submit with the primary ERA and verify the secondary payer's billing split requirements.

Action
Resubmit
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-89 Mean?

OA-89 appears in coordination of benefits situations where the primary payer removed professional fees and the adjustment is passed to the secondary payer. The secondary payer will evaluate the professional component under its own billing rules.

When CARC 89 appears on a remittance, the payer has removed the professional fee component from the billed charges. This is not a full claim denial — the facility or technical component may have been paid — but the separately billed professional fees were rejected or zeroed out.

The most common scenario behind CARC 89 involves hospital-based outpatient services where the provider incorrectly split the professional and technical components. If the payer's contract pays a global rate that includes both components, a separately billed professional fee claim will be stripped as duplicative. This also happens when incorrect modifiers are used — for example, billing modifier 26 (professional component) when the payer expects a global code, or omitting the modifier entirely.

CARC 89 predominantly appears with Group Code CO, making the removed professional fees a provider write-off. This is a revenue-critical denial for practices and hospitals because professional fees often represent a significant portion of the total charge. Systematic CO-89 denials for a particular payer or service line usually point to a billing configuration problem rather than a one-off coding error. Audit your professional/technical component split rules by payer and correct the root cause in your charge master or billing system.

OA-89 appears occasionally in coordination of benefits situations. In all cases, resolving CARC 89 starts with understanding whether the professional fee should have been billed separately or was properly bundled by the payer.

Common Causes

Cause Frequency
Coordination of benefits professional fee adjustment In multi-payer situations, the primary payer removed the professional fee and the adjustment is passed to the secondary payer under OA Most Common

How to Resolve

Determine whether the professional fee was correctly billed as a separate claim, verify modifier usage, and either correct the billing or appeal the payer's bundling decision.

  1. Submit to the secondary payer File a secondary claim with the primary ERA showing the OA-89 adjustment. Ensure the professional component is coded correctly for the secondary payer's billing rules.
  2. Process the secondary ERA Review the secondary adjudication. If the secondary payer also strips the professional fee, determine if the billing split needs to be reconfigured for that payer.
Do Not Appeal This Code

This adjustment is typically correct as processed. Review the specific circumstances before taking further action.

How to Prevent OA-89

General Prevention

Also Filed As

The same CARC 89 may appear with different Group Codes:

CO-89

Related Denial Codes

OA-13 — Date of Death Precedes Date of Service OA-19 — Workers' Compensation Claim OA-20 — Liability Carrier Responsible OA-21 — No-Fault Carrier Responsible OA-22 — Care Covered by Another Payer (COB)

Sources

  1. https://www.mdclarity.com/denial-code/89
  2. https://www.codingahead.com/denial-code-89/
  3. https://ambci.org/medical-billing-and-coding-certification-blog/guide-to-claim-adjustment-reason-codes-carcs
  4. Codes maintained by X12. Visit x12.org for official definitions.