Denial Code CO-96: Description, Meaning and How to Fix It
The service is not covered under the plan. Often paired with a RARC explaining why.
Official description
Non-covered charge(s).
Common cause
The service is excluded from the plan, or coverage/benefit details were not verified.
How to fix it
Check the RARC for specifics, verify benefits, and determine whether the patient is responsible (with a valid ABN/waiver where required) or whether to appeal.
Related denial codes
- CO-204: The item or service is not a covered benefit under this plan.
- 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.