What does denial code CARC 46 mean on a dental claim, and can it be appealed?

On a dental remittance, CARC 46 means: A retired way of saying the plan does not cover the service. X12 deactivated this code on 2003-10-16. X12's own note on the row directs users to code 96 instead. 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. No source read for this page pairs a specific remark code with it. Dentovio's appealability verdict — structural: verify the plan terms. Treat the substance as a 96 non-covered decision and work it that way. If a payer is still sending 46 on a live remittance, that is worth raising with the payer separately — its own remittance is out of step with the code set it is required to use.

Coverage, exclusions, and plan terms · Last verified 2026-08-30

CARC 46 denial code on dental claims

Independent publisher · Drafted with AI assistance, verified against primary sources · Credentialed review pending

CARC 46 is the “Not covered (retired code)” code on a dental remittance. A plan term controls, so verify the plan and the facts before appealing.

Deactivated code. X12 stopped CARC 46 on 2003-10-16. X12's own note on the row directs users to code 96 instead. Payers do still send retired codes, so it is documented here rather than dropped.

Group code: Moot: the code is deactivated. A payer sending it is sending a code the maintainer retired more than twenty years ago. 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.

Registry entry: X12 Claim Adjustment Reason Code 46 — in the code set since 1995-01-01; deactivated 2003-10-16; X12's own note on the row directs users to code 96 instead. Read on the list published 2025-11-01.

Verdict

Structural — verify the plan terms

The denial reflects a plan term such as an exclusion or exhausted limit. Verify that the payer used the correct plan and facts before deciding how the contract assigns responsibility.

Treat the substance as a 96 non-covered decision and work it that way. If a payer is still sending 46 on a live remittance, that is worth raising with the payer separately — its own remittance is out of step with the code set it is required to use.

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.

What it means in dental

A retired way of saying the plan does not cover the service.

This record exists to show what a genuinely dead code looks like, because misreading the registry's dates is a common way to get a live code published as a dead one. Around 110 CARCs carry a stop date, and X12 usually adds a note naming the replacement, as it did here. A code with only a Last Modified date — code 95, revised in 2007, is the one most often misreported — is current.

What to do

1.Work the denial as a non-covered decision under code 96
2.Read the remark code for the actual exclusion
3.Flag the stale code to the payer; a deactivated code on a current remittance is a payer system problem, not yours

Remark codes verified with this CARC

No source read for this page pairs a remark code with CARC 46. 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

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