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CO-200 Denial Code: Expenses During Lapse in Coverage

CO-200 means the expenses were incurred during a lapse in coverage. The patient had coverage before and possibly after, but not on the date of service, often because of unpaid premiums, a grace period, or a gap between enrollment periods.

Quick facts

Code
CO-200 (CARC 200)
Status
Active In use since October 31, 2006.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The payer isn't paying. The provider absorbs it from this payer's perspective, though coverage may be reinstated later.
  • PR (Patient Responsibility): The patient is responsible because they had no active coverage on the date of service, unless coverage is reinstated retroactively.
Official description
Expenses incurred during lapse in coverage
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-200 means

CARC 200 reads “Expenses incurred during lapse in coverage.” It’s different from a simple termination. The patient’s coverage has a gap: they were covered before, and may be covered again, but the date of service falls in a period with no active coverage.

Gaps often come from missed premium payments, employer enrollment errors, COBRA elections not yet made or paid, or a delay between one plan ending and another starting. Some gaps can be fixed retroactively; others can’t.

Example: a patient with a marketplace plan misses a premium payment. After the grace period, the plan terminates coverage back to the end of the first month of the grace period. Claims in the remaining months are denied CO-200.

Common causes

  • Unpaid premiums leading to suspended or terminated coverage.
  • Grace period rules that pend and then deny claims.
  • COBRA elections not made or paid by the deadline.
  • Employer enrollment errors, such as a delayed rehire or benefit change.
  • Medicaid redetermination gaps where coverage lapsed and was later restored.

How to fix it

  1. Check eligibility for the exact date of service, and ask the payer whether the lapse is final or pending.
  2. Talk to the patient about premium status, COBRA elections, or employer enrollment.
  3. If coverage is reinstated, ask the payer to reprocess the claim or resubmit per its instructions.
  4. Check for other coverage during the lapse, including Medicaid (which may have retroactive eligibility) or a new employer plan.
  5. Bill the patient if the lapse stands and no other coverage applies.

How to prevent it

  • Verify eligibility before every visit, especially for patients with marketplace or COBRA coverage. See eligibility denials.
  • Watch for grace period flags in eligibility responses and discuss them with patients.
  • Collect estimated payments or set up financial agreements for patients whose coverage is at risk.
  • Hold non-urgent services during known lapses when appropriate.
  • Track CO-200 by payer to identify plans where lapses are frequent.

Remark codes that may appear with CO-200

  • N30 (Patient ineligible for this service.): The patient is ineligible for this service on the date it occurred.
  • PR-27 (Expenses incurred after coverage terminated.): Coverage terminated before the service date, with no indication it resumed.
  • PR-26 (Expenses incurred prior to coverage.): The service was before coverage began.
  • CO-177 (Patient has not met the required eligibility requirements.): An eligibility requirement wasn't met.
  • CO-166 (These services were submitted after this payers responsibility for processing claims under this plan ended.): The payer's responsibility for the plan ended.

CO-200 FAQ

What is a grace period, and how does it affect CO-200?

Many plans give members a grace period to pay late premiums. For some marketplace plans with premium tax credits, claims in the later part of the grace period may be pended and then denied if premiums aren't paid. Rules vary by plan type.

Can a lapse be reversed?

Yes, sometimes. If the patient pays the overdue premium within the plan's rules, or the employer corrects an enrollment error, coverage may be reinstated. Ask the payer to reprocess the claim.

Should I bill the patient right away?

Check first whether reinstatement is possible, whether other coverage applies, and what the group code says. Then bill the patient if the lapse stands.

How is CO-200 different from CO-27?

CO-27 says coverage ended before the service. CO-200 describes a gap: the patient's coverage lapsed for a period, often with coverage before and after it, which makes reinstatement worth checking.

Does a COBRA election fix CO-200?

It can. COBRA coverage elected and paid within the allowed time is generally retroactive to the date the prior coverage ended, so claims denied during the election period may be reprocessed once the plan updates eligibility.