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CO-193 Code: Original Payment Decision Maintained

CO-193 means the payer reviewed the claim, often after a reconsideration, appeal, or reopening, and determined it was processed properly. The original payment decision stands. The amount keeps the same responsibility as the original adjustment.

Quick facts

Code
CO-193 (CARC 193)
Status
Active In use since February 28, 2006; last modified January 27, 2008.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The original contractual or denied amount stays with the provider.
  • PR (Patient Responsibility): The original patient responsibility is unchanged.
  • OA (Other Adjustment): Informational use where the review simply confirms the original processing.
Official description
Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-193 means

CARC 193 reads “Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.” It’s the payer’s response after a second look: a reconsideration, redetermination, reopening, or internal review. The payer found no error and is keeping the original outcome.

CO-193 doesn’t explain the original reason. To know why the claim was denied or reduced in the first place, go back to the original ERA and its CARCs and RARCs.

Example: a practice requests reconsideration of a denied line but sends only a letter with no new documentation. The payer reviews it, finds the original decision consistent with policy, and issues an ERA with CO-193.

Common causes

  • Appeal without new information, such as records, policy citations, or corrected coding.
  • Original decision consistent with policy or contract.
  • Wrong issue addressed in the appeal, so the payer’s actual reason wasn’t rebutted.
  • Submitting a review request when a corrected claim was needed, or vice versa.

How to handle it

  1. Go back to the original remittance and confirm the original CARC and RARCs.
  2. Read the review letter if one was sent; it may explain the rationale.
  3. Decide whether to escalate. If you have strong evidence, file the next appeal level before the deadline.
  4. Strengthen the next submission with records, payer policy language, contract terms, or a corrected claim if the error was yours.
  5. If no further appeal is available, post the result and close the account according to the group code.

How to prevent it

  • Address the exact denial reason in every appeal with specific evidence.
  • Choose the right path: corrected claim for billing errors, appeal for disagreements with payer decisions. See claim rejection vs. denial.
  • Track appeal outcomes by payer and reason so you learn which appeals succeed. ERA Analyzer can track upheld decisions across remittances.
  • Keep appeal deadlines on a calendar so escalation isn’t missed.

Remark codes that may appear with CO-193

  • MA01 (Alert: If you do not agree with what we approved for these services, you may appeal our decision.): Appeal-rights alert. Check whether a further level of appeal is available and its deadline.
  • OA-18 (Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)): The claim was denied as a duplicate, which can happen if a review request was sent as a new claim.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Missing or invalid information. Resubmissions with new errors may deny again for this reason.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Medical necessity, a common underlying reason that remains after review.

CO-193 FAQ

Is CO-193 a new denial?

No. It confirms the original decision. The underlying reason is the CARC on the original remittance, so go back to that to understand why.

What can I do after CO-193?

Look for the next appeal level. Many payers have multiple levels, and Medicare has five. Each level has its own deadline and requirements. If there are no further levels, the decision is final.

Why did my corrected claim come back CO-193?

The payer may have treated it as a reopening or review rather than a replacement claim. Check whether you used the correct resubmission code and original reference number in box 22.

Should I resubmit the same claim after CO-193?

No. Sending the same claim again usually produces a duplicate denial or the same outcome. Either escalate through the appeal process with new evidence or accept the decision.

Does CO-193 count as a new denial in my reports?

Track it as an appeal outcome rather than a fresh denial. Counting it twice inflates your denial rate and hides how often your appeals are upheld.