Claim adjustment reason code · X12
CARC 197: precertification or authorization absent.
CARC 197 says the payer has no pre-treatment authorization or notification linked to this service. Start by checking whether one exists and whether it matches the claim.
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What X12 says CARC 197 means
Precertification/authorization/notification/pre-treatment absent.
CARC 197 · Start 10/31/2006, last modified 05/01/2018.
The wording covers four things: precertification, authorization, notification and pre-treatment. Plans use different names for similar steps, so the code does not tell you which one was missing.
Check before you appeal
A CARC 197 does not always mean nobody asked. It often means the authorization on file does not match the claim. Compare each of these against the approval letter or portal record:
- Authorization number on the claim.
- Procedure codes and units approved versus billed.
- Approved date range versus the date of service.
- Approved rendering and billing provider and NPI.
- Approved place of service and facility.
If there was no authorization
Whether a late or retroactive authorization is possible depends entirely on the payer and the contract. Some allow a request within a stated window; others do not. Read your provider manual, ask the payer in writing and keep the answer. Do not bill the patient for a CO adjustment unless your contract or a signed patient notice allows it.
Prevention
Check authorization requirements at scheduling, store the authorization number with the appointment and re-check it when the code, date or provider changes. Most CARC 197 denials trace to a change after the original approval.
Sources
- X12: Claim Adjustment Reason Codes — code text, start and last-modified dates (list dated 10/30/2026, retrieved 2026-11-01)
Every code description and rule above was retrieved from these pages on November 1, 2026. Payers revise code lists, contracts and policies, so confirm anything that affects a claim or a deadline with the payer.
Frequently asked questions
Can I get paid after a CARC 197?
Sometimes. If an authorization existed but was linked wrongly, a corrected claim can fix it. If none existed, it depends on whether the payer allows retroactive authorization.
Is CARC 197 the same as CARC 50?
No. CARC 50 is a medical necessity decision. CARC 197 is that no authorization or notification was found.
Does this code only apply to prior authorization?
The X12 wording includes precertification, authorization, notification and pre-treatment, so it can be used for any of those.
Not legal, billing or medical advice
This page explains published code lists and rules and runs a lookup in your browser. It cannot see your claim, your contract or any payer's policy. Confirm with the payer or your Medicare Administrative Contractor before you resubmit, appeal or bill a patient.