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CO-190 Denial Code: Included in SNF Qualified Stay

CO-190 means payment for the service is included in the skilled nursing facility's allowance for a qualified (covered) stay. The outside provider or supplier generally must be paid by the SNF under arrangement, not by the payer.

Quick facts

Code
CO-190 (CARC 190)
Status
Active In use since October 31, 2005.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The payer won't pay the outside provider separately. The provider generally seeks payment from the SNF, not the patient.
Official description
Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-190 means

CARC 190 reads “Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.” When a patient is in a covered SNF stay, most services they receive are part of the SNF’s payment. Medicare calls this consolidated billing. An outside lab, therapy provider, supplier, or other entity that bills Medicare directly for an included service will be denied with CO-190, often with N106 or N107.

Some services are excluded from consolidated billing and can be billed separately, including many physicians’ professional services and certain high-cost services. Which services are excluded is defined in Medicare’s consolidated billing rules and can change.

Example: an outpatient therapy clinic treats a patient without realizing they’re in a Medicare Part A covered SNF stay. The clinic’s Part B claim is denied CO-190. The clinic must seek payment from the SNF under an arrangement.

Common causes

  • Not knowing the patient is in a covered SNF stay, especially for recently admitted patients.
  • Supplies, labs, or therapy provided to SNF residents and billed directly.
  • Ambulance or transport services that fall under consolidated billing in some circumstances.
  • No arrangement with the SNF for how outside services are paid.
  • Eligibility checks that miss the SNF stay.

How to fix it

  1. Confirm the SNF stay dates and whether the patient was in a covered Part A stay on the date of service.
  2. Check whether the service is excluded from consolidated billing. If it is, and the claim was denied in error, request reprocessing or appeal.
  3. If included, bill the SNF according to your agreement. Don’t resubmit to the payer.
  4. If the patient wasn’t in a covered stay, provide dates and ask the payer to correct its records and reprocess.
  5. Don’t bill the patient for included services.

How to prevent it

  • Ask about SNF residence at scheduling and check eligibility for active SNF stays.
  • Set up written arrangements with SNFs you serve, including pricing and billing steps.
  • Train staff on consolidated billing exclusions for the services you provide.
  • Monitor CO-190 by location to find facilities where coordination breaks down. ERA Analyzer can group these denials by patient and date. More on bundling rules in preventable denials.

Specialty notes

Therapy providers (PT/OT/SLP), labs, imaging, DME suppliers, and ambulance companies are the most affected by SNF consolidated billing.

Remark codes that may appear with CO-190

  • N106 (Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF.): Payment for services furnished to SNF inpatients can only be made to the SNF.
  • N107 (Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim.): Services to SNF inpatients must be billed on the SNF's inpatient claim.
  • N538 (A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.): The facility is responsible for paying outside providers for these services.
  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): The service is included in payment for another service, a general bundling code.
  • CO-171 (Payment is denied when performed/billed by this type of provider in this type of facility.): Denied for this provider type in this facility type.
  • CO-B7 (This provider was not certified/eligible to be paid for this procedure/service on this date of service.): The provider wasn't eligible to be paid for this service on the date.

CO-190 FAQ

What is SNF consolidated billing?

Under Medicare Part A, a skilled nursing facility is paid for most services its residents receive during a covered stay. The SNF bills Medicare for them, and outside suppliers such as labs, therapy, and DME must be paid by the SNF. Certain services, like many physician professional services, are excluded.

Can I bill the patient after CO-190?

Generally no. Bill the SNF under your arrangement with it. The resident is not responsible for services included in the SNF's payment.

How do I know a patient is in a covered SNF stay?

Ask at intake whether the patient lives in or was recently discharged from a nursing facility, and check eligibility for an active Part A SNF stay before providing services.