Denial Code Reference

CO-1 Deductible Amount

CO-2 Coinsurance Amount

CO-3 Co-payment Amount

CO-4 The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthc...

CO-5 The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to...

CO-6 The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835...

CO-7 The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the...

CO-8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Ref...

CO-9 The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare P...

CO-10 The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcar...

CO-11 The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Polic...

CO-12 The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthcare P...

CO-13 The date of death precedes the date of service

CO-14 The date of birth follows the date of service

CO-15 The authorization number is missing, invalid, or does not apply to the billed services or...

CO-16 Claim/service lacks information or has submission/billing error(s). Usage: Do not use this...

CO-17 Requested information was not provided or was insufficient/incomplete. At least one Remark...

CO-18 Exact duplicate claim/service (Use only with Group Code OA except where state workers' com...

CO-19 This is a work-related injury/illness and thus the liability of the Worker's Compensation...

CO-20 This injury/illness is covered by the liability carrier

CO-21 This injury/illness is the liability of the no-fault carrier

CO-22 This care may be covered by another payer per coordination of benefits

CO-23 The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only...

CO-24 Charges are covered under a capitation agreement/managed care plan

CO-25 Payment denied. Your Stop loss deductible has not been met

CO-26 Expenses incurred prior to coverage

CO-27 Expenses incurred after coverage terminated

CO-28 Coverage not in effect at the time the service was provided

CO-29 The time limit for filing has expired

CO-30 Payment adjusted because the patient has not met the required eligibility, spend down, wai...

CO-31 Patient cannot be identified as our insured

CO-32 Our records indicate the patient is not an eligible dependent

CO-33 Insured has no dependent coverage

CO-34 Insured has no coverage for newborns

CO-35 Lifetime benefit maximum has been reached

CO-36 Balance does not exceed co-payment amount

CO-37 Balance does not exceed deductible

CO-38 Services not provided or authorized by designated (network/primary care) providers

CO-39 Services denied at the time authorization/pre-certification was requested

CO-40 Charges do not meet qualifications for emergent/urgent care. Usage: Refer to the 835 Healt...

CO-41 Discount agreed to in Preferred Provider contract

CO-42 Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45)

CO-43 Gramm-Rudman reduction

CO-44 Prompt-pay discount

CO-45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Us...

CO-46 This (these) service(s) is (are) not covered

CO-47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid

CO-48 This (these) procedure(s) is (are) not covered

CO-49 This is a non-covered service because it is a routine/preventive exam or a diagnostic/scre...

CO-50 These are non-covered services because this is not deemed a 'medical necessity' by the pay...

CO-51 These are non-covered services because this is a pre-existing condition. Usage: Refer to t...

CO-52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perf...

CO-53 Services by an immediate relative or a member of the same household are not covered

CO-54 Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healt...

CO-55 Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer...

CO-56 Procedure/treatment has not been deemed 'proven to be effective' by the payer. Usage: Refe...

CO-57 Payment denied/reduced because the payer deems the information submitted does not support...

CO-58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid pla...

CO-59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery o...

CO-60 Charges for outpatient services are not covered when performed within a period of time pri...

CO-61 Adjusted for failure to obtain second surgical opinion

CO-62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization

CO-63 Correction to a prior claim

CO-64 Denial reversed per Medical Review

CO-65 Procedure code was incorrect. This payment reflects the correct code

CO-66 Blood Deductible

CO-67 Lifetime reserve days. (Handled in QTY, QTY01=LA)

CO-68 DRG weight. (Handled in CLP12)

CO-69 Day outlier amount

CO-70 Cost outlier - Adjustment to compensate for additional costs

CO-71 Primary Payer amount

CO-72 Coinsurance day. (Handled in QTY, QTY01=CD)

CO-73 Administrative days

CO-74 Indirect Medical Education Adjustment

CO-75 Direct Medical Education Adjustment

CO-76 Disproportionate Share Adjustment

CO-77 Covered days. (Handled in QTY, QTY01=CA)

CO-78 Non-Covered days/Room charge adjustment

CO-79 Cost Report days. (Handled in MIA15)

CO-80 Outlier days. (Handled in QTY, QTY01=OU)

CO-81 Discharges

CO-82 PIP days

CO-83 Total visits

CO-84 Capital Adjustment. (Handled in MIA)

CO-85 Patient Interest Adjustment (Use Only Group code PR)

CO-86 Statutory Adjustment

CO-87 Transfer amount

CO-88 Adjustment amount represents collection against receivable created in prior overpayment

CO-89 Professional fees removed from charges

CO-90 Ingredient cost adjustment. Usage: To be used for pharmaceuticals only

CO-91 Dispensing fee adjustment

CO-92 Claim Paid in full

CO-93 No Claim level Adjustments

CO-94 Processed in Excess of charges

CO-95 Plan procedures not followed

CO-96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of eith...

CO-97 The benefit for this service is included in the payment/allowance for another service/proc...

CO-98 The hospital must file the Medicare claim for this inpatient non-physician service

CO-99 Medicare Secondary Payer Adjustment Amount

CO-100 Payment made to patient/insured/responsible party

CO-101 Predetermination: anticipated payment upon completion of services or claim adjudication

CO-102 Major Medical Adjustment

CO-103 Provider promotional discount (e.g., Senior citizen discount)

CO-104 Managed care withholding

CO-105 Tax withholding

CO-106 Patient payment option/election not in effect

CO-107 The related or qualifying claim/service was not identified on this claim. Usage: Refer to...

CO-108 Rent/purchase guidelines were not met. Usage: Refer to the 835 Healthcare Policy Identific...

CO-109 Claim/service not covered by this payer/contractor. You must send the claim/service to the...

CO-110 Billing date predates service date

CO-111 Not covered unless the provider accepts assignment

CO-112 Service not furnished directly to the patient and/or not documented

CO-113 Payment denied because service/procedure was provided outside the United States or as a re...

CO-114 Procedure/product not approved by the Food and Drug Administration

CO-115 Procedure postponed, canceled, or delayed

CO-116 The advance indemnification notice signed by the patient did not comply with requirements

CO-117 Transportation is only covered to the closest facility that can provide the necessary care

CO-118 ESRD network support adjustment

CO-119 Benefit maximum for this time period or occurrence has been reached

CO-120 Patient is covered by a managed care plan

CO-121 Indemnification adjustment - compensation for outstanding member responsibility

CO-122 Psychiatric reduction

CO-123 Payer refund due to overpayment

CO-124 Payer refund amount - not our patient

CO-125 Submission/billing error(s). At least one Remark Code must be provided (may be comprised o...

CO-126 Deductible -- Major Medical

CO-127 Coinsurance -- Major Medical

CO-128 Newborn's services are covered in the mother's Allowance

CO-129 Prior processing information appears incorrect. At least one Remark Code must be provided...

CO-130 Claim submission fee

CO-131 Claim specific negotiated discount

CO-132 Prearranged demonstration project adjustment

CO-133 The disposition of this service line is pending further review. (Use only with Group Code...

CO-134 Technical fees removed from charges

CO-135 Interim bills cannot be processed

CO-136 Failure to follow prior payer's coverage rules. (Use only with Group Code OA)

CO-137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes

CO-138 Appeal procedures not followed or time limits not met

CO-139 Contracted funding agreement - Subscriber is employed by the provider of services. Use onl...

CO-140 Patient/Insured health identification number and name do not match

CO-141 Claim spans eligible and ineligible periods of coverage

CO-142 Monthly Medicaid patient liability amount

CO-143 Portion of payment deferred

CO-144 Incentive adjustment, e.g. preferred product/service

CO-145 Premium payment withholding

CO-146 Diagnosis was invalid for the date(s) of service reported

CO-147 Provider contracted/negotiated rate expired or not on file

CO-148 Information from another provider was not provided or was insufficient/incomplete. At leas...

CO-149 Lifetime benefit maximum has been reached for this service/benefit category

CO-150 Payer deems the information submitted does not support this level of service

CO-151 Payment adjusted because the payer deems the information submitted does not support this m...

CO-152 Payer deems the information submitted does not support this length of service. Usage: Refe...

CO-153 Payer deems the information submitted does not support this dosage

CO-154 Payer deems the information submitted does not support this day's supply

CO-155 Patient refused the service/procedure

CO-156 Flexible spending account payments. Note: Use code 187

CO-157 Service/procedure was provided as a result of an act of war

CO-158 Service/procedure was provided outside of the United States

CO-159 Service/procedure was provided as a result of terrorism

CO-160 Injury/illness was the result of an activity that is a benefit exclusion

CO-161 Provider performance bonus

CO-162 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for s...

CO-163 Attachment/other documentation referenced on the claim was not received

CO-164 Attachment/other documentation referenced on the claim was not received in a timely fashio...

CO-165 Referral absent or exceeded

CO-166 These services were submitted after this payers responsibility for processing claims under...

CO-167 This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy...

CO-168 Service(s) have been considered under the patient's medical plan. Benefits are not availab...

CO-169 Alternate benefit has been provided

CO-170 Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835...

CO-171 Payment is denied when performed/billed by this type of provider in this type of facility....

CO-172 Payment is adjusted when performed/billed by a provider of this specialty. Usage: Refer to...

CO-173 Service/equipment was not prescribed by a physician

CO-174 Service was not prescribed prior to delivery

CO-175 Prescription is incomplete

CO-176 Prescription is not current

CO-177 Patient has not met the required eligibility requirements

CO-178 Patient has not met the required spend down requirements

CO-179 Patient has not met the required waiting requirements. Usage: Refer to the 835 Healthcare...

CO-180 Patient has not met the required residency requirements

CO-181 Procedure code was invalid on the date of service

CO-182 Procedure modifier was invalid on the date of service

CO-183 The referring provider is not eligible to refer the service billed. Usage: Refer to the 83...

CO-184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. U...

CO-185 The rendering provider is not eligible to perform the service billed. Usage: Refer to the...

CO-186 Level of care change adjustment

CO-187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Accou...

CO-188 This product/procedure is only covered when used according to FDA recommendations

CO-189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there...

CO-190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay

CO-191 Not a work related injury/illness and thus not the liability of the workers' compensation...

CO-192 Non standard adjustment code from paper remittance. Usage: This code is to be used by prov...

CO-193 Original payment decision is being maintained. Upon review, it was determined that this cl...

CO-194 Anesthesia performed by the operating physician, the assistant surgeon or the attending ph...

CO-195 Refund issued to an erroneous priority payer for this claim/service

CO-196 Claim/service denied based on prior payer's coverage determination

CO-197 Precertification/authorization/notification/pre-treatment absent

CO-198 Precertification/notification/authorization/pre-treatment exceeded

CO-199 Revenue code and Procedure code do not match

CO-200 Expenses incurred during lapse in coverage

CO-201 Patient is responsible for amount of this claim/service through 'set aside arrangement' or...

CO-202 Non-covered personal comfort or convenience services

CO-203 Discontinued or reduced service

CO-204 This service/equipment/drug is not covered under the patient's current benefit plan

CO-205 Pharmacy discount card processing fee

CO-206 National Provider Identifier - missing

CO-207 National Provider identifier - Invalid format

CO-208 National Provider Identifier - Not matched

CO-209 Per regulatory or other agreement. The provider cannot collect this amount from the patien...

CO-210 Payment adjusted because pre-certification/authorization not received in a timely fashion

CO-211 National Drug Codes (NDC) not eligible for rebate, are not covered

CO-212 Administrative surcharges are not covered

CO-213 Non-compliance with the physician self referral prohibition legislation or payer policy

CO-214 Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for clai...

CO-215 Based on subrogation of a third party settlement

CO-216 Based on the findings of a review organization or the payer's findings

CO-217 Based on payer reasonable and customary fees. No maximum allowable defined by legislated f...

CO-218 Based on entitlement to benefits. Note: If adjustment is at the Claim Level, the payer mus...

CO-219 Based on extent of injury. Usage: If adjustment is at the Claim Level, the payer must send...

CO-220 The applicable fee schedule/fee database does not contain the billed code. Please resubmit...

CO-221 Claim is under investigation. Note: If adjustment is at the Claim Level, the payer must se...

CO-222 Exceeds the contracted maximum number of hours/days/units by this provider for this period...

CO-223 Adjustment code for mandated federal, state or local law/regulation that is not already co...

CO-224 Patient identification compromised by identity theft. Identity verification required for p...

CO-225 Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting withi...

CO-226 Information requested from the Billing/Rendering Provider was not provided or not provided...

CO-227 Information requested from the patient/insured/responsible party was not provided or was i...

CO-228 Denied for failure of this provider, another provider or the subscriber to supply requeste...

CO-229 Partial charge amount not considered by Medicare due to the initial claim Type of Bill bei...

CO-230 No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Pr...

CO-231 Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the...

CO-232 Institutional Transfer Amount. Usage: Applies to institutional claims only and explains th...

CO-233 Services/charges related to the treatment of a hospital-acquired condition or preventable...

CO-234 This procedure is not paid separately. At least one Remark Code must be provided (may be c...

CO-235 Sales Tax

CO-236 This procedure or procedure/modifier combination is not compatible with another procedure...

CO-237 Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised...

CO-238 Claim spans eligible and ineligible periods of coverage, this is the reduction for the ine...

CO-239 Claim spans eligible and ineligible periods of coverage. Rebill separate claims

CO-240 The diagnosis is inconsistent with the patient's birth weight. Usage: Refer to the 835 Hea...

CO-241 Low Income Subsidy (LIS) Co-payment Amount

CO-242 Services not provided by network/primary care providers

CO-243 Services not authorized by network/primary care providers

CO-244 Payment reduced to zero due to litigation. Additional information will be sent following t...

CO-245 Provider performance program withhold

CO-246 This non-payable code is for required reporting only

CO-247 Deductible for Professional service rendered in an Institutional setting and billed on an...

CO-248 Coinsurance for Professional service rendered in an Institutional setting and billed on an...

CO-249 This claim has been identified as a readmission. (Use only with Group Code CO)

CO-250 The attachment/other documentation that was received was the incorrect attachment/document...

CO-251 The attachment/other documentation that was received was incomplete or deficient. The nece...

CO-252 An attachment/other documentation is required to adjudicate this claim/service. At least o...

CO-253 Sequestration - reduction in federal payment

CO-254 Claim received by the dental plan, but benefits not available under this plan. Submit thes...

CO-255 The disposition of the related Property & Casualty claim (injury or illness) is pending du...

CO-256 Service not payable per managed care contract

CO-257 The disposition of the claim/service is undetermined during the premium payment grace peri...

CO-258 Claim/service not covered when patient is in custody/incarcerated. Applicable federal, sta...

CO-259 Additional payment for Dental/Vision service utilization

CO-260 Processed under Medicaid ACA Enhanced Fee Schedule

CO-261 The procedure or service is inconsistent with the patient's history

CO-262 Adjustment for delivery cost. Usage: To be used for pharmaceuticals only

CO-263 Adjustment for shipping cost. Usage: To be used for pharmaceuticals only

CO-264 Adjustment for postage cost. Usage: To be used for pharmaceuticals only

CO-265 Adjustment for administrative cost. Usage: To be used for pharmaceuticals only

CO-266 Adjustment for compound preparation cost. Usage: To be used for pharmaceuticals only

CO-267 Claim/service spans multiple months. At least one Remark Code must be provided (may be com...

CO-268 The Claim spans two calendar years. Please resubmit one claim per calendar year

CO-269 Anesthesia not covered for this service/procedure. Usage: Refer to the 835 Healthcare Poli...

CO-270 Claim received by the medical plan, but benefits not available under this plan. Submit the...

CO-271 Prior contractual reductions related to a current periodic payment as part of a contractua...

CO-272 Coverage/program guidelines were not met

CO-273 Coverage/program guidelines were exceeded

CO-274 Fee/Service not payable per patient Care Coordination arrangement

CO-275 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) no...

CO-276 Services denied by the prior payer(s) are not covered by this payer

CO-277 The disposition of the claim/service is undetermined during the premium payment grace peri...

CO-278 Performance program proficiency requirements not met. (Use only with Group Codes CO or PI)...

CO-279 Services not provided by Preferred network providers. Usage: Use this code when there are...

CO-280 Claim received by the medical plan, but benefits not available under this plan. Submit the...

CO-281 Deductible waived per contractual agreement. Use only with Group Code CO

CO-282 The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835...

CO-283 Attending provider is not eligible to provide direction of care

CO-284 Precertification/authorization/notification/pre-treatment number may be valid but does not...

CO-285 Appeal procedures not followed

CO-286 Appeal time limits not met

CO-287 Referral exceeded

CO-288 Referral absent

CO-289 Services considered under the dental and medical plans, benefits not available

CO-290 Claim received by the dental plan, but benefits not available under this plan. Claim has b...

CO-291 Claim received by the medical plan, but benefits not available under this plan. Claim has...

CO-292 Claim received by the medical plan, but benefits not available under this plan. Claim has...

CO-293 Payment made to employer

CO-294 Payment made to attorney

CO-295 Pharmacy Direct/Indirect Remuneration (DIR)

CO-296 Precertification/authorization/notification/pre-treatment number may be valid but does not...

CO-297 Claim received by the medical plan, but benefits not available under this plan. Submit the...

CO-298 Claim received by the medical plan, but benefits not available under this plan. Claim has...

CO-299 The billing provider is not eligible to receive payment for the service billed

CO-300 Claim received by the Medical Plan, but benefits not available under this plan. Claim has...

CO-301 Claim received by the Medical Plan, but benefits not available under this plan. Submit the...

CO-302 Precertification/notification/authorization/pre-treatment time limit has expired

CO-303 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) no...

CO-304 Claim received by the medical plan, but benefits not available under this plan. Submit the...

CO-305 Claim received by the medical plan, but benefits not available under this plan. Claim has...

CO-306 Type of bill is inconsistent with the patient status. Usage: Refer to the 835 Healthcare P...

CO-307 Medicare Maximum Fair Price Standard Default Refund Amount Adjustment. At least one Remark...

CO-308 Payment is adjusted due to contracted funding agreement between the payer and provider