Denial Code CO-204: Description, Meaning and How to Fix It
The item or service is not a covered benefit under this plan.
Official description
This service/equipment/drug is not covered under the patient's current benefit plan.
Common cause
Plan exclusion, or benefits not verified before the service.
How to fix it
Verify benefits, determine patient responsibility (with an ABN where applicable), or appeal if you believe it should be covered.
Related denial codes
- CO-96: The service is not covered under the plan. Often paired with a RARC explaining why.
- CO-119: The patient has hit a benefit maximum (visits, dollars, or occurrences) for the period.
- PR-49: A routine or preventive service is not covered (or was billed with a routine exam), and it is patient responsibility.
- N130: The service is subject to plan restrictions; check the benefit documents.
- CO-45: The amount billed is higher than the payer's contracted (allowed) rate. The difference is a contractual write-off, not a patient balance.
- CO-16: The claim is missing required information or has an error. It is almost always paired with a RARC that names the specific missing field.