Denial code list

Most searched

The codes billers look up most, by measured search volume.

CO 97 · CO 96 · OA 23 · PR 204 · CO 109 · CO 197 · CO 45 · CO 50

Remark codes

An adjustment code says a claim was reduced. A remark code says why. You need both.

• N130The member's plan restricts this service, and the payer has pointed you at the benefit document instead of naming the restriction.
• N115The decision came from a Local Coverage Determination, the regional Medicare policy that says when this service is covered.
• N30The patient was not eligible for this particular service on that date. That is narrower than not being covered at all, and the difference matters.
• MA04This was billed as a secondary claim and the payer has no record of what the primary did with it.
• M80Another service billed for the same patient on the same day already absorbed this one.
• N56The procedure code does not match what was done, or was not valid on that date of service.
• N59The payer has pointed you at the provider manual rather than naming the rule it applied.
• N822A modifier the payer needed was missing from the procedure.
• N362More days or units were billed than the payer will accept for that code.
• N290The rendering provider identifier is missing, incomplete or wrong.
• N381The payer is pointing at your contract rather than naming the rule it applied.
• MA130The claim was unprocessable, so it was never adjudicated and carries no appeal rights at all.
• N211The payer is telling you this particular decision carries no appeal rights.
• N19The payer treats this procedure as incidental to the main one, so it pays nothing on its own.
• M15Services billed separately were bundled, because the payer considers them components of one procedure.
• M51A procedure code is missing, incomplete or not valid.
• N522This duplicates a claim that is already crossing over from another payer.

Contractual and patient responsibility

• PR 1Applied to the patient deductible.
• PR 2Applied to patient coinsurance.
• PR 3Applied to the patient co-payment.
• CO 45Charge is above the contracted rate. The difference is written off.
• CO 131A negotiated discount specific to this claim was applied.
• CO 253A flat federal sequestration reduction was applied.

Prior authorisation

• CO 197The payer says no prior authorisation was on file.
• PR 197The payer says no prior authorisation was on file.
• CO 198Authorised, but more units or visits were billed than approved.
• CO 15The authorisation number is missing, invalid, or does not match.

Missing information

• CO 16Something the payer needed was missing or wrong on the claim.
• PR 16Something the payer needed was missing or wrong on the claim.
• CO 125The submission itself had an error.
• CO 252The payer wants supporting documentation attached.
• CO 226The payer asked you for information and did not get it, or did not get enough.

Coding

• CO 5The procedure does not match the place of service billed.
• CO 4The procedure code and the modifier do not agree.
• CO 11The diagnosis does not match the procedure billed.
• CO 59Reduced under multiple-procedure rules.
• CO 8The procedure does not match the provider type or specialty on file.
• CO 6The procedure does not fit the patient's age.
• CO 181The procedure code was not valid on that date of service.
• CO 146The diagnosis was not valid on that date of service.

Medical necessity

• CO 58The payer decided the service should not have been done where it was done.
• CO 50The payer decided the service was not medically necessary.
• PR 50The payer decided the service was not medically necessary.
• CO 167The diagnosis billed is not covered for this service.
• PR 167The diagnosis billed is not covered for this service.
• CO 55Treated as experimental or investigational.
• PR 55Treated as experimental or investigational.

Eligibility

• CO 185The rendering provider is not eligible to perform the service billed.
• CO 242The provider was out of network, or not the patient's assigned primary care provider.
• PR 27Coverage had ended on the date of service.
• CO 27Coverage had ended on the date of service.
• PR 26Service fell before coverage started.
• CO 26Service fell before coverage started.
• CO B7The provider was not certified or eligible for this service on that date.
• CO 24The patient is in a capitated or managed-care plan, so this is paid under that contract.
• CO 31The payer cannot find this patient as a member.
• CO 170This payer does not pay this service when this type of provider performs it.

Bundling and NCCI

• CO 236This procedure and another one billed the same day cannot be billed together under NCCI.
• CO 97The payer says this is already paid inside another service.
• CO 234This procedure is not paid separately.
• CO B15A required prior service was not billed or not covered.
• CO 107The related service this one depends on was not on the claim.

Other

• CO 246This code is reported for tracking only and was never going to pay.

Timely filing

• CO 29Filed after the payer deadline.

Units and frequency

• CO 151The payer says the records do not support this many units or visits.

Benefit maximums

• PR 119The benefit maximum for this period has been reached.
• CO 119The benefit maximum for this period has been reached.
• PR 35The lifetime benefit maximum has been reached.

Coordination of benefits

• OA 22Another plan should pay first.
• CO 22Another plan should pay first.
• OA 109Wrong payer or wrong contractor for this claim.
• CO 109Wrong payer or wrong contractor for this claim.
• OA 23A prior payer already adjusted this, and that adjustment carries over.
• CO 23A prior payer already adjusted this, and that adjustment carries over.

Duplicates

• OA 18The payer treated this as an exact duplicate.
• CO 18The payer treated this as an exact duplicate.

Non-covered

• PR 96Not a covered charge under this plan.
• CO 96Not a covered charge under this plan.
• PR 204Not covered under the patient’s current benefit plan.
• CO 204Not covered under the patient’s current benefit plan.
• PR 49Treated as a routine or preventive service the plan does not cover.