89Denial Code (CARC)Active
CARC 89 Denial Code - Professional Fees Adjustment
Code 89 indicates that the professional fees associated with a claim have been removed from the billed charges. This means that the payer has not allowed payment for the professional component of the services rendered.
Who Pays: Group Code Liability
Typically, code 89 is adjusted under the CO group code, indicating a contractual write-off where the provider absorbs the cost, and the patient cannot be billed. However, if it's determined that the patient is liable according to their plan, the PR group code may apply, making it billable to the patient.
Why Claims Get Code 89
- The payer's contract excludes professional fees from coverage.
- Professional fees were incorrectly included in a facility-based claim.
- A bundled payment arrangement does not cover professional fees separately.
- Coding error where professional fees were not itemized correctly.
- The service was rendered by a provider not credentialed with the payer.
How to Fix & Resubmit
- Verify the payer's contract to confirm if professional fees should be covered separately.
- Check the claim to ensure that professional fees were billed correctly and separately from facility charges.
- Review the provider's credentialing status with the payer to ensure they are authorized to bill for professional fees.
- If the fees were included in error, adjust the claim to remove the professional fees and resubmit.
- If the fees should be covered, gather supporting documentation and submit an appeal to the payer.
Corrected Claim or Appeal?
Submit a corrected claim if professional fees were billed in error. If the fees should be covered, submit an appeal with documentation supporting the inclusion of professional fees.
Preventing Future 89 Denials
- Ensure contracts with payers clearly outline coverage for professional fees.
- Separate professional and facility fees on claims to avoid confusion.
- Verify provider credentialing status with payers before billing professional fees.
- Regularly review payer policies to align billing practices with coverage rules.