RARCN386ReferenceCurrentVerified Aug 15, 2026RARC N386
AR Guide Workflow
Medical Necessity
The payer determined the service was not medically necessary or reasonable according to its policy. These denials are documentation-driven.
AR Guide explanation
What it means
The decision is based on a National Coverage Determination (NCD).
AR Guide knowledge
Common denial category
Medical Necessity — The payer determined the service was not medically necessary or reasonable according to its policy. These denials are documentation-driven.
AR Guide knowledge
Common usage
- Medicare claims denied per an NCD
- Accompanies medical necessity denials
About this guidance: Note
Reference
Commonly paired CARCs
CARCs this remark commonly accompanies on the ERA/EOB, per the AR Guide pairing data.
CARC50These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.CARC55Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.CARC150Payer deems the information submitted does not support this level of service.CARC151Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.CARC167This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.CARC233Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
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