CARC Code 85
The claim information does not support the billed service or the total charges are incorrect.
What this denial means
When you see CARC code 85 on your Explanation of Benefits (EOB), it means your insurer has denied the claim with the following reason: the claim information does not support the billed service or the total charges are incorrect.
This code is one of the most common denial reasons in the CARC system and appears across both employer-sponsored and ACA marketplace plans. How you respond depends on whether the denial is a patient-side or provider-side issue.
Can you appeal this?
This is typically a provider billing matter. Often a billing error correctable by your provider. Ask your provider's billing office to review and resubmit before filing a patient appeal.
Start by contacting your provider's billing office. In many cases you may owe nothing — the adjustment is between your provider and the insurer. If you believe the denial was applied incorrectly, your provider can submit a corrected claim.
Related reading
Not legal or medical advice. Rebuttal is a document drafting tool, not a law firm. Review your letter before submitting and consult a licensed professional for legal questions specific to your plan.