CARC B14 Active

OA-B14: Only One Visit/Consultation Per Physician Per Day Covered

TL;DR

Only one visit or consultation per physician per day is covered. If a second visit was medically necessary and distinct, appeal with documentation and modifier 25. If the visits should have been combined, consolidate into a single encounter.

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-B14 Mean?

CARC B14 indicates the payer denied a claim because only one visit or consultation per physician per day is covered under the plan. The provider billed for two or more evaluation and management services for the same physician and patient on the same date, and the payer only pays for one.

This rule prevents unbundling of a single encounter into multiple visits. However, there are legitimate situations where two separate encounters on the same day are appropriate — for example, when a patient returns for a new problem, or when a separately identifiable E/M service is performed alongside a procedure. In these cases, modifier 25 (Significant, Separately Identifiable Evaluation and Management Service) should be appended to the second E/M service.

If the second visit was a follow-up for the same condition seen earlier in the day, the services should be consolidated into a single encounter rather than billed as two separate visits.

How to Resolve

Determine if the visits were distinct encounters, apply modifier 25 if appropriate, and resubmit or appeal.

  1. Review same-day claims Compare the two billed visits for the same physician and patient on the same date. Identify the chief complaints, diagnoses, and services for each.
  2. Determine if visits were distinct Assess whether the second visit was for a separately identifiable medical issue or was a continuation of the first visit.
  3. Apply modifier 25 if appropriate If the second E/M service was a separately identifiable encounter, append modifier 25 and resubmit the claim.
  4. Appeal with documentation Submit an appeal with medical records for both encounters showing different chief complaints, different diagnoses, or a separate procedure requiring its own E/M visit.
  5. Consolidate if not distinct If the visits were for the same condition on the same day, combine them into a single encounter billed at the appropriate E/M level.
Do Not Appeal This Code

Only One Visit/Consultation Per Physician Per Day Covered grouped under OA is an Other Adjustment that doesn't fall into the standard contractual write-off or patient responsibility categories. Whether action is needed depends on the specific reason — review any accompanying RARC codes and payer guidance to decide whether this is a final adjustment to accept or an issue to resolve through resubmission.

Also Filed As

The same CARC B14 may appear with different Group Codes:

CO-B14 PR-B14

Related Denial Codes

OA-74 — Indirect Medical Education Adjustment OA-75 — Direct Medical Education Adjustment OA-76 — Disproportionate Share Adjustment OA-85 — Patient Interest Adjustment OA-89 — Professional Fees Removed from Charges

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.cms.gov/regulations-and-guidance/guidance/manuals
  3. Codes maintained by X12. Visit x12.org for official definitions.