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CO-219 Denial Code: Based on Extent of Injury

CO-219 means the payer adjusted the claim based on the extent of injury. The payer, typically a workers' compensation or property and casualty carrier, has accepted only certain injuries or body parts, and the billed care falls outside what it accepted.

Quick facts

Code
CO-219 (CARC 219)
Status
Active In use since January 27, 2008; last modified July 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The provider is responsible for the adjusted amount under the payer's decision. In workers' compensation, balance billing the injured worker is generally restricted by state rules.
  • OA (Other Adjustment): Sometimes used when the payer reports the extent-of-injury decision without assigning it to provider or patient.
Official description
Based on extent of injury. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF).
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-219 means

CARC 219 means the adjustment is based on extent of injury. It is used mainly by workers’ compensation and property and casualty payers, which accept liability for a specific injury, not for everything a patient is treated for. If a worker’s claim was accepted for a shoulder strain and the claim includes treatment of the neck, the carrier may deny the neck care with CARC 219 until the extent of injury is expanded.

The official usage tells you where to find the rule the payer relied on. If the adjustment is at the claim level, look for the Insurance Policy Number REF segment with qualifier IG in loop 2100 of the 835, which carries the jurisdictional regulation. If it is at the line level, look at the Healthcare Policy Identification REF in loop 2110.

Common causes

  • Treatment of a body part not listed in the accepted claim.
  • Diagnosis codes in box 21 that describe a condition the carrier has disputed.
  • Pre-existing or degenerative conditions the carrier considers unrelated to the work injury.
  • Extent-of-injury dispute pending before the state workers’ compensation agency.
  • Claim number or injury date on the bill that points to a different accepted injury.

How to fix it

  1. Read the policy reference on the ERA and any explanation of review or letter from the carrier.
  2. Confirm which injuries were accepted with the adjuster, and get it in writing.
  3. If the diagnosis on the bill was wrong, correct it and resubmit according to the state’s workers’ compensation billing rules.
  4. If you believe the care is related, request reconsideration with medical records that connect the condition to the work injury. Many states have a formal dispute process for extent-of-injury decisions.
  5. Follow jurisdictional rules on whether and when you can bill the patient or their health plan. Workers’ compensation rules often prohibit billing the injured worker while a claim is open.

How to prevent it

  • Get the accepted body parts and diagnoses from the adjuster before treating.
  • Code the diagnoses that match the documented work injury and keep unrelated conditions separate.
  • Ask the carrier to review and expand the accepted injury before treating a new body part.
  • Keep workers’ comp claim numbers and injury dates accurate on every bill.

Specialty notes

Orthopedics, physical therapy, chiropractic, and pain management see CO-219 most. State workers’ compensation systems differ widely in dispute timelines and billing rules, so follow the rules for the jurisdiction on the claim rather than group-health practices.

Remark codes that may appear with CO-219

  • N202 (Alert: Additional information/explanation will be sent separately.): The payer will explain the accepted injuries separately.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to policy or jurisdictional documents behind the decision.
  • CO-P2 (Not a work related injury/illness and thus not the liability of the workers' compensation carrier): The whole injury or illness was found not work-related, rather than only part of it.
  • CO-P16 (Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.): The provider was not authorized to treat injured workers in the jurisdiction.
  • CO-P1 (State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.): A property and casualty state-mandated requirement, explained in remark codes.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Medical necessity denial, which differs from a finding that the body part is outside the accepted injury.

CO-219 FAQ

What does extent of injury mean in workers' compensation?

It refers to which injuries, conditions, or body parts the carrier has accepted as part of the work-related claim. Treatment for conditions outside that scope may be denied as not related.

Where do I find the regulation behind CO-219?

The official usage says the payer must send a reference: at the claim level in the 835 REF segment with qualifier IG in loop 2100, or at the line level in the Healthcare Policy Identification REF in loop 2110. Check your ERA for that reference.

Can I bill the patient's health insurance instead?

Possibly, if the condition is determined not to be work-related and the health plan's rules allow it. Coordinate carefully, because health plans often deny injury claims pending the workers' comp outcome.