OA-199: Revenue Code / Procedure Code Mismatch

What Does OA-199 Mean?

OA-199 may appear in coordination of benefits scenarios where the revenue code/procedure code mismatch affects claim adjudication across multiple payers. The coding error needs to be corrected regardless of which payer is processing the claim.

CARC 199 fires when the payer's claim editing system detects that the revenue code and procedure code submitted on an institutional claim (UB-04) are incompatible. Every institutional claim line requires both a revenue code (which identifies the department or type of service, like radiology or laboratory) and a procedure code (the specific CPT or HCPCS code). These two codes must logically correspond — a laboratory revenue code should pair with a lab procedure code, not a radiology CPT.

This is a purely technical billing error, not a clinical or coverage issue. The payer is not questioning whether the service was medically necessary or covered — they are rejecting the claim because the code combination is invalid according to their editing rules. The root cause is almost always a charge description master (CDM) mapping error, a data entry mistake during claim preparation, or an outdated CDM that has not been updated after annual coding changes.

CARC 199 is specific to institutional billing and does not apply to professional claims (CMS-1500). It is most commonly seen in hospital outpatient departments, ambulatory surgery centers, and other facility-based settings that bill on UB-04 forms. The resolution is straightforward: identify the correct revenue code for the procedure (or the correct procedure code for the revenue code), correct the claim, and resubmit.

How to Resolve

Identify the mismatched revenue code and procedure code, determine the correct pairing, and resubmit the corrected claim.

1. Correct the coding error Fix the revenue code and procedure code mismatch on the claim, then resubmit to the primary payer first.
2. Resubmit to secondary payer Once the primary payer processes the corrected claim, forward the updated remittance to the secondary payer for adjudication.

How to Prevent OA-199

• Ensure revenue code and procedure code validation is applied uniformly regardless of which payer will receive the claim
• Run institutional claims through a pre-submission edit check before sending to any payer

Also Filed As

The same CARC 199 may appear with different Group Codes:

Related Denial Codes