CARC 199 Active

PR-199: Revenue Code and Procedure Code Mismatch

TL;DR

The patient was assigned a charge for a coding error. Correct the codes and request reprocessing to remove the patient charge.

Action
Review & Decide
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
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 PR-199 Mean?

With PR (Patient Responsibility), the patient was assigned the cost due to the code mismatch. This is unusual for a coding error and likely should not be the patient's responsibility. Contact the payer to clarify and correct the claim.

CARC 199 is a coding error specific to institutional (UB-04) claims where the revenue code and the CPT/HCPCS procedure code do not form a valid combination. Revenue codes categorize the type of service or department, while procedure codes identify the specific service performed. Payers validate these combinations and reject claims when the codes conflict.

This denial commonly results from data entry errors, outdated chargemaster entries, confusion between facility and professional billing requirements, or unbundling errors. The fix is straightforward — identify the correct revenue code for the procedure and resubmit.

How to Resolve

  1. Correct the coding error Fix the revenue/procedure code combination.
  2. Request reprocessing Submit the corrected claim and request the patient charges be reversed.
Do Not Appeal This Code

This is a billing/coding error where the revenue code does not match the procedure code. Correct the code combination and resubmit the claim rather than filing an appeal.

How to Prevent PR-199

Also Filed As

The same CARC 199 may appear with different Group Codes:

CO-199 OA-199

Related Denial Codes

PR-4 — Procedure Code Inconsistent with Modifier PR-5 — Procedure Code Inconsistent with Place of Service PR-6 — Procedure/Revenue Code Inconsistent with Patient Age PR-7 — Procedure/Revenue Code Inconsistent with Patient Gender PR-8 — Procedure Code Inconsistent with Provider Type/Specialty

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://www.mdclarity.com/denial-code/199
  3. 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
  4. https://www.aapc.com/resources/claim-adjustment-reason-codes
  5. Codes maintained by X12. Visit x12.org for official definitions.