CARC B23 Active

PR-B23: Procedure Not Authorized Per CLIA Proficiency Test

TL;DR

The laboratory is not CLIA-authorized to perform this test. Verify your CLIA certificate covers the test category. If certified, appeal with your certificate. If not, refer the test to a certified lab.

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-B23 Mean?

CARC B23 indicates the payer denied the claim because the laboratory performing the test is not authorized to do so under its Clinical Laboratory Improvement Amendments (CLIA) certification. CLIA requires all clinical laboratories to be certified and to meet quality standards for each type of testing they perform.

This denial occurs when the lab's CLIA certificate does not include the specific test category, the lab failed a proficiency test for the analyte, the CLIA certificate expired, the test falls outside the scope of the lab's certificate level (e.g., a waived lab performing moderate complexity testing), or CMS imposed sanctions restricting the lab's testing capabilities.

Laboratories must maintain proficiency testing compliance for every test they perform and bill. Failing a proficiency test for a specific analyte can result in loss of authorization to bill for that test until remediation is complete.

How to Resolve

Verify your CLIA certificate covers the test, appeal with certification documentation if authorized, or refer the test to a certified lab.

  1. Check CLIA certificate Review your laboratory's current CLIA certificate to verify the authorized testing categories, specialties, and subspecialties.
  2. Verify proficiency test status Check whether you passed the most recent proficiency test for the specific analyte or test category.
  3. Appeal if authorized If your CLIA certificate covers the test, appeal with a copy of the certificate showing the CLIA number, effective dates, and authorized testing specialties.
  4. Remediate if failed If a proficiency test was failed, complete the remediation process and include documentation of successful remediation with the appeal.
  5. Refer to certified lab if not authorized If your lab is not authorized for this test category, refer future tests to a certified reference laboratory.
  6. Verify CLIA number on claim Confirm the correct CLIA number is submitted on the claim.
Do Not Appeal This Code

Procedure Not Authorized Per CLIA Proficiency Test grouped under PR places the financial responsibility on the patient. The specific reason depends on the context of this adjustment — review any accompanying RARC codes for detail. Because this represents a placement of responsibility rather than a coverage denial, an appeal isn't the right action; verify the placement is correct before billing the patient.

Also Filed As

The same CARC B23 may appear with different Group Codes:

CO-B23 OA-B23

Related Denial Codes

PR-13 — Date of Death Precedes Date of Service PR-14 — Date of Birth Follows Date of Service PR-19 — Workers' Compensation Claim PR-20 — Liability Carrier Responsible PR-21 — No-Fault Carrier Responsible

Sources

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