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CO-217 Denial Code (Deactivated): P&C Reasonable & Customary

CO-217 meant a property and casualty payer priced the claim using its reasonable and customary fees, because no legislated fee schedule set a maximum. X12 deactivated it and its notes point payers to code P5.

X12 deactivated CARC217 on July 1, 2014. Payers should no longer use it on new remittances, but it can still appear on older ERAs, corrected claims, and appeals.

Quick facts

Code
CO-217 (CARC 217)
Status
Deactivated StoppedJuly 1, 2014 (in use since January 27, 2008).
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The reduction to the reasonable and customary amount was treated as a provider adjustment.
Official description
Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Property and Casualty only)
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-217 meant

CARC 217 applied to property and casualty claims, such as auto or liability medical bills, in situations with no legislated fee schedule to set a maximum payment. The payer instead reduced the charge to what it judged to be the reasonable and customary fee for the service.

What replaced it

X12’s note says to use code P5, so CO-P5 is the replacement, with the same property and casualty restriction. Where a state does have a workers’ compensation fee schedule, payers use CO-P12 instead. Health plan reductions to a fee schedule or contract rate are reported with CO-45.

If you still see CO-217

It should only appear on older auto, liability, or similar claims. Ask the payer which reasonable and customary database or methodology it used and at what percentile. If the allowed amount is well below typical charges for your area, request reconsideration with supporting data. Whether the patient can be billed for the difference depends on state law and the type of coverage, so confirm before sending a balance bill.

  • CO-P5 (Based on payer reasonable and customary fees.): Named replacement: based on payer reasonable and customary fees, property and casualty only.
  • CO-P12 (Workers' compensation jurisdictional fee schedule adjustment.): Workers' compensation jurisdictional fee schedule adjustment, used where a legislated schedule exists.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The general code for charges above a fee schedule or contracted amount.

CO-217 FAQ

When does reasonable and customary pricing apply?

When a property and casualty claim is not governed by a state-legislated fee schedule, some payers limit payment to what they consider reasonable and customary for the service and area.

Can I dispute a reasonable and customary reduction?

Usually yes. Ask the payer what data source it used and provide your own evidence of typical charges, or any agreement you have with the payer.