CO-24: covered under a capitation agreement.

What X12 says CARC 24 means

Charges are covered under a capitation agreement/managed care plan.

CARC 24 · Start 01/01/1995, last modified 09/30/2007.

In plain terms: The payer says these charges are already covered by a capitation or managed care arrangement, so no separate fee-for-service payment is made.

What it means on a remittance

Under capitation a plan pays a provider group a set amount per member per period instead of paying per claim. When a claim arrives for a service the plan treats as already funded that way, it reports CARC 24 with a zero payment. The code is a routing signal: the money goes to the capitated entity, and the claim usually needs to go there.

Typical causes

• The patient is assigned to a capitated primary care group or medical group, and you are not that group.
• You are the capitated provider, so fee-for-service billing for the covered service is not payable.
• The patient's assignment on the payer's file changed, or the payer's roster is out of date.
• The service is part of a bundle the capitation agreement covers.

These are common billing patterns, not a diagnosis of your claim. The remittance and the payer's policy decide.

What to check

1. Verify the patient's plan and any assigned group or primary care provider for the date of service.
2. Read your contract or fee schedule for what is capitated and what is billable fee-for-service.
3. Ask the payer which entity holds the capitation for this member and date.
4. Check whether the service needed a referral or was provided outside the assigned network.

Correct, resubmit or appeal

If another group holds the capitation, bill that group or its administrator, as the payer directs. If you believe the service is carved out of capitation, point to the contract section and ask for reprocessing. If the member assignment was wrong, ask the payer to correct it and reprocess. When you appeal Medicare, the redetermination window is 120 days from receipt of the notice. Managed care plans set their own appeal windows in the plan or provider agreement. Retired CARC 38 (services not provided or authorized by designated providers) lists CARC 242 and 243 as its replacements in the X12 note, which are worth reading beside CARC 24.

Medicare dates that apply

Medicare claims must be filed no later than the close of the period ending 1 calendar year after the date of service (42 CFR 424.44(a)(1)), with exceptions in 424.44(b). A redetermination request must be filed within 120 calendar days from the date a party receives the notice, receipt is presumed 5 days after the notice date (42 CFR 405.942(a)), and a late request can be considered for good cause (405.942(b)). Clerical errors, including inaccurate data entry, are handled by the contractor as reopenings instead of redeterminations (42 CFR 405.980(a)(3)). The tool above runs the date math.

Related codes

X12 does not publish a table that pairs each CARC with remark codes. The payer picks the remark code and prints it beside the CARC on the same remittance line, so read it on your own remittance and look it up in the X12 list.

Other codes: CARC 109 (not covered by this payer), CARC 197 (authorization absent). The full lookup reads any code on this page.

Worked example (hypothetical)

A urgent-care visit by a member of a capitated medical group comes back CO-24 with a zero payment. The payer confirms the member's group; the biller sends the claim to the group's administrator and notes the new payer.

Sources

• X12: Claim Adjustment Reason Codes — code text, usage notes and dates (list dated 10/30/2026, retrieved 2026-11-02)
• X12: Remittance Advice Remark Codes — remark code text (retrieved 2026-11-02)
• 42 CFR 424.44, 42 CFR 405.942 and 42 CFR 405.980 — eCFR, current through 2026-10-29 (retrieved 2026-11-02)

Code descriptions are X12 copyrighted material, quoted here only for the codes on this page and linked to the owner. For the full lists, use X12. Every rule above was read from these pages on November 2, 2026. Payers revise code lists, contracts and policies, so confirm anything that affects a claim or a deadline with the payer.