# CARC 226 denial code on dental claims > What does denial code CARC 226 mean on a dental claim, and can it be appealed? URL: https://dentovio.com/dental-claim-denial-codes/carc-226 Last verified: 2026-08-30 Dentovio is an independent publisher — not a payer, the ADA, X12, CAQH CORE, or any government agency. Code meanings and remark-code meanings on this page are Dentovio's own wording, written from the official X12 Claim Adjustment Reason Code and Remittance Advice Remark Code lists and linked back to them; X12 holds the copyright in those lists and its descriptions are not reproduced here. CDT codes are referenced by number only; CDT is the American Dental Association's copyrighted code set and this page does not reproduce ADA descriptors. Appealability verdicts are Dentovio editorial classification, not a standard. Every fact traces to the code steward's registry, a federal rule or manual, a HIPAA operating rule, an association publication, or a named payer's own document — never to a billing blog. This page was drafted with AI assistance and verified against the primary sources linked here. It has not been reviewed by a credentialed dental billing specialist, attorney, or clinician. Educational billing reference only — not billing, legal, or clinical advice. Plan contracts control individual outcomes, and processing policies usually live in the payer's provider manual rather than in the signed agreement. ## Direct answer On a dental remittance, CARC 226 means: The payer asked the billing or rendering provider for information and never got a usable answer — nothing arrived, it arrived too late, or what arrived did not cover the question. Like 252, its own definition requires an accompanying remark code. X12 assigns it no group code, so the group code on the remittance is the payer's choice under its own contract and it, not the CARC, decides who is assigned the balance. The code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — depends: check the facts first. Whether the information can still be supplied is a payer-contract question, not something the code answers. Find the original request, establish what was sent and when, and ask the payer in writing what window remains before treating the balance as final. Registry entry: X12 Claim Adjustment Reason Code 226 — in the code set since 2008-09-21; description last revised 2013-07-01; active, with no deactivation date. Read on the list published 2025-11-01. Group code: 226 appears nowhere in the CAQH CORE code-combination workbook — not in the master sheet and not in any business scenario — so no operating rule fixes its group code. The payer chooses. A group code always travels with a CARC, and it — not the CARC — assigns financial responsibility, so read the one on your remittance rather than assuming. This code's own definition requires an accompanying remark code, so a remittance carrying it without one is incomplete. ## What it means in dental context This is the end state of an unanswered documentation request, and it is the provider-side code — the member-side counterpart is 227. It sits outside the CAQH CORE combination list entirely, which means there is no standard-mandated group code for it and no standard remark pairing, whatever a code guide asserts. ## Appealability: Depends — check the facts first The appealability verdicts on these pages are Dentovio's editorial classification. No standards body or payer publishes an appealability taxonomy: X12 defines what a code means, not what to do about it. Each verdict is built from the code's own mechanics and the payer and federal documents cited on the page, and it is a starting point for triage rather than a prediction of any outcome. A valid contract term may control, while a factual error may be contested. Run the checks on this page before using the appeal window. Whether the information can still be supplied is a payer-contract question, not something the code answers. Find the original request, establish what was sent and when, and ask the payer in writing what window remains before treating the balance as final. ## What to do 1. Trace the original information request and whatever the office sent in response 2. Ask the payer in writing what response window applies and whether it has closed 3. Fix the intake side: an unanswered request is usually a mail or portal-routing failure, not a clinical one ## Remark codes No source read for this page pairs a remark code with CARC 226. X12 defines no CARC-to-RARC pairings at all: payer crosswalks are specific to that payer's own internal reason codes, and the CAQH CORE combination list binds only payers operating inside its business scenarios. Read the remark code on your own remittance. ## Read with this code - [CARC 252 — Attachment required](https://dentovio.com/dental-claim-denial-codes/carc-252/index.html.md) - [CARC 227 — Patient never answered](https://dentovio.com/dental-claim-denial-codes/carc-227/index.html.md) - [CARC 250 — Wrong document sent](https://dentovio.com/dental-claim-denial-codes/carc-250/index.html.md) ## Sources - X12 Claim Adjustment Reason Codes (external code list 139) (list updated 2025-11-01): - X12 Remittance Advice Remark Codes (external code list 411) (list updated 2026-07-01): - 45 CFR 162.1602 — HIPAA adoption of the 835 remittance standard that carries these codes: - CAQH CORE-required Code Combinations for CORE-defined Business Scenarios, v3.10.0, February 2026 (Master sheet and Business Scenario #1): ## Related - [Dental billing and claims hub](https://dentovio.com/dental-billing/index.html.md) - [All dental denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md) - [Payer documentation requirements](https://dentovio.com/dental-claim-documentation/index.html.md) - [Dental insurance prompt-pay laws by state](https://dentovio.com/dental-prompt-pay-laws/index.html.md) - [Dental claim appeal letters](https://dentovio.com/dental-claim-appeal-letters/index.html.md)