CARC Code
57
Payment denied/reduced because the payer deems the information submitted does not support this level of service.
How to resolve this denial
Submit appeal with complete medical records supporting the level of service billed
- 1
Obtain the complete medical record documenting the clinical need for the service
- 2
Review the payer's LCD/NCD or coverage policy for the billed procedure
- 3
Prepare a Letter of Medical Necessity from the treating physician
- 4
Submit a formal appeal with clinical records, the letter, and peer-reviewed literature
- 5
Track the appeal and follow up within 30 days
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about CO-57 — stats, related codes, appeal template
35%
Recovery Rate
21-45 days
Avg. Resolution
Hard
Difficulty
Common
Frequency
Payer-Specific Notes
How major payers handle CARC 57 by specialty.
Blue Cross Blue Shield
BCBS requires appeal submission within 180 days for most plans.
Common 835 Combinations
CARC 57 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 57 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 57 indicating: "Payment denied/reduced — info submitted does not support this level of service.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
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