Reference·CAS Segment·CAS02
X12 835 Reference

CAS02 in X12 835: A Field Guide to Claim Adjustment Reason Code

Jul 28, 2026 · 4 min read
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CAS01 tells you who owes the money. CAS02 tells you why — and it is pulled from a code list long enough that most test suites only ever exercise a dozen values, which is exactly why a real denial reason so often shows up in a billing system as a blank line or a generic "adjustment applied" message.

Quick answer

CAS02 is the Claim Adjustment Reason Code, better known as a CARC — a numeric code from a shared external code list that explains the specific reason behind the adjustment amount reported in the same CAS iteration. It always pairs with the group code in CAS01, which says who is responsible, while CAS02 says why.

A few common CARC examples

1
Deductible Amount — the amount applied to the patient's deductible — typically paired with a PR group code
45
Charge exceeds fee schedule/maximum allowable — the standard contractual write-off reason — typically paired with a CO group code
96
Non-covered charge(s) — the service is not covered under the plan — can pair with PR or CO depending on the circumstances
97
Payment is included in the allowance for another service — a bundling reason, common when a procedure is not separately reimbursable

Example

Synthetic example Generated by Synthibase
CAS*CO*97*40.00

A synthetic bundling adjustment: reason code 97 explains that the $40.00 write-off happened because this charge was bundled into another service's allowed amount. Synthetic remittance data.

Where this trips people up

Because the CARC list is long and payers use different subsets of it, teams building denial-reason displays often hardcode a lookup table sized to whatever handful of codes appeared in early sample files, then route everything else to a generic fallback message. That gap stays invisible until a payer returns a legitimate but less common CARC, and the front-end staff who need to know exactly why a claim was reduced instead see nothing actionable. Synthetic test data should include CARCs well outside the handful everyone tests first.

X12 835 CAS Segment Guide: Fields, Format, and Testing Gotchas
EDI 835 Remittance Advice: Complete Guide for Healthcare IT
How to Test 835 Remittance Reconciliation Before Go-Live
Stop guessing which CARCs your system will meet in production
Synthibase generates synthetic 835 files with a wide spread of claim adjustment reason codes, not just the common handful, so your denial-reason mapping gets exercised before a payer surprises you in production.
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