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CO-260 Code: Medicaid ACA Enhanced Fee Schedule

CO-260 means the claim was processed under the Medicaid Affordable Care Act enhanced fee schedule. It explains a payment calculated at the enhanced primary care rate rather than the standard state Medicaid rate.

Quick facts

Code
CO-260 (CARC 260)
Status
Active In use since January 26, 2014.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The difference between the billed charge and the enhanced rate is a provider adjustment. It is not billable to the Medicaid patient.
Official description
Processed under Medicaid ACA Enhanced Fee Schedule
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-260 means

CARC 260 says the claim was processed under the Medicaid ACA Enhanced Fee Schedule. The Affordable Care Act included a temporary requirement for state Medicaid programs to pay eligible primary care physicians Medicare-level rates for certain evaluation and management and vaccine administration services during 2013 and 2014. States used CARC 260 to show that a payment was calculated under that enhanced schedule.

After the federal requirement ended, some states continued enhanced primary care payments with their own funds, and their remittances may still reference the code. Its main value is reconciliation: it tells you which schedule the payment came from.

When it appears

  • Eligible primary care services billed to Medicaid by physicians who attested to eligibility.
  • Medicaid managed care plans passing through enhanced rates required by the state.
  • Reprocessed older claims from the enhanced-rate years.
  • State-funded continuations of enhanced primary care rates.

Reading the payment

An enhanced-rate payment usually looks better than a typical Medicaid payment for the same service. The ERA still shows an adjustment between your billed charge and the allowed amount, and CARC 260 explains that the allowed amount came from the enhanced schedule. If you bill the same service to Medicaid for a provider who is not eligible, you should expect the standard rate instead, with an ordinary fee schedule adjustment. Differences like that are a quick way to spot a missing attestation or a provider whose specialty is on file incorrectly with the state.

How to handle it

  1. Confirm eligibility. Check that the rendering provider’s attestation and specialty were on file for the date of service.
  2. Compare the payment to the enhanced rate for that service and year.
  3. If the enhanced rate was not applied where it should have been, contact the state program or managed care plan and request reprocessing.
  4. If applied correctly, post the difference from billed charges as a contractual adjustment.
  5. Do not bill the Medicaid patient for any difference.

How to prevent problems

  • Keep records of provider attestations and eligibility for enhanced-rate programs.
  • Load the enhanced fee schedule into expected-payment calculations for eligible services.
  • Watch for state policy changes that start, extend, or end enhanced primary care rates.
  • Review Medicaid payments by rate type; an ERA Analyzer can show whether eligible services were paid at the enhanced rate.

Specialty notes

This is mostly relevant to family medicine, internal medicine, and pediatric practices with meaningful Medicaid volume. Specialists outside the eligible categories generally do not receive the enhanced rate.

Remark codes that may appear with CO-260

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to program documents describing the enhanced fee schedule.
  • N59 (Alert: Please refer to your provider manual for additional program and provider information.): Refers you to the provider manual for program details.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The standard fee schedule or contracted rate reduction.
  • CO-144 (Incentive adjustment, e.g. preferred product/service.): An incentive adjustment that increases payment.
  • CO-223 (Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code…): A mandated adjustment without a specific code.

CO-260 FAQ

What was the Medicaid ACA enhanced fee schedule?

The Affordable Care Act required state Medicaid programs to pay certain primary care services by eligible physicians at Medicare rates in 2013 and 2014. Some states continued enhanced primary care rates afterward with their own funding.

Who qualified for the enhanced rate?

Physicians in family medicine, general internal medicine, pediatrics, and related subspecialties who met the attestation requirements, for specified evaluation and management and vaccine administration services. Current eligibility depends on your state's program.

Can I still receive CO-260 today?

Possibly, in states that kept an enhanced primary care rate or when older claims are reprocessed. Check your state Medicaid program's rules.