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CO-269 Denial Code: Anesthesia Not Covered for Procedure

CO-269 means the payer doesn't cover anesthesia services for this particular service or procedure. The procedure itself may be covered, but the payer's policy says separate anesthesia isn't payable for it, often because moderate sedation or local anesthesia is considered sufficient.

Quick facts

Code
CO-269 (CARC 269)
Status
Active In use since March 1, 2015; last modified July 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The anesthesia provider absorbs the amount and can't bill the patient without a valid advance agreement where the payer allows one.
  • PR (Patient Responsibility): Used when the patient is responsible, for example after agreeing in advance to pay for anesthesia the plan doesn't cover.
Official description
Anesthesia not covered for this service/procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-269 means

CARC 269 says anesthesia is not covered for this service or procedure. The payer has a policy that limits separately billed anesthesia for certain procedures. The procedure may be paid to the surgeon or endoscopist, but the anesthesia claim is denied because, under the policy, separate anesthesia wasn’t needed.

These policies usually focus on procedures that can often be done with local anesthesia or moderate sedation administered by the proceduralist, such as some endoscopic procedures, minor surgical procedures, or certain pain injections. They typically allow separate anesthesia when the patient has specific risk factors, like a difficult airway, significant cardiopulmonary disease, certain behavioral conditions, or a documented failure of moderate sedation.

The usage note points to the 835 Healthcare Policy Identification segment, where the payer may identify the policy.

Common causes

  • Procedure on the payer’s list of services where separate anesthesia isn’t routinely covered.
  • Qualifying diagnoses not reported on the anesthesia claim, even though they were documented.
  • Physical status or risk information missing, such as physical status modifiers or pre-anesthesia assessment details.
  • Patient doesn’t meet the policy’s criteria.
  • Anesthesia billed for a procedure that the payer considers inherently not requiring it.

How to fix it

  1. Get the policy and note its qualifying conditions.
  2. Review the anesthesia record and pre-anesthesia assessment for those conditions.
  3. If qualifying conditions were documented but not coded, add the diagnoses in box 21, link them in box 24E, include physical status modifiers as required, and send a corrected claim with resubmission code 7 in box 22.
  4. If the claim was complete, appeal with the record and a statement from the anesthesia provider explaining why anesthesia was needed.
  5. If the patient didn’t meet the criteria, write off under CO, or bill the patient only if the payer reports PR or a valid advance agreement exists.

How to prevent it

  • Check anesthesia policies before scheduling procedures that are commonly done without separate anesthesia.
  • Document risk factors in the pre-anesthesia assessment clearly.
  • Coordinate diagnosis coding between the proceduralist and anesthesia group so qualifying conditions reach the anesthesia claim.
  • Request authorization where payers offer it for anesthesia on these procedures. See authorization and referral denials.

Specialty notes

Anesthesia groups covering endoscopy centers and office-based procedure suites see CO-269 most. Dental anesthesia under medical plans has its own coverage rules, which vary by payer and state.

Remark codes that may appear with CO-269

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan documents describing when anesthesia is covered.
  • N431 (Not covered with this procedure.): Not covered with this procedure.
  • CO-194 (Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.): Anesthesia performed by the operating or assistant surgeon, a different anesthesia restriction.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Not medically necessary, the reason often behind anesthesia policy denials.
  • CO-97 (The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.): Payment included in another service, used when sedation is bundled.
  • CO-11 (The diagnosis is inconsistent with the procedure.): The diagnosis doesn't support the service, which can apply when anesthesia is covered only for certain conditions.

CO-269 FAQ

Why would anesthesia not be covered when the procedure is?

Some payers consider certain procedures, such as some endoscopies, injections, or minor procedures, appropriate under local anesthesia or moderate sedation. Separate anesthesia is covered only when the patient has conditions that make it medically necessary.

How do I appeal CO-269?

Review the payer's anesthesia policy, then submit documentation of the patient-specific factors it lists, such as airway issues, significant comorbidities, or inability to cooperate. Include the pre-anesthesia assessment.

Do diagnosis codes matter?

Yes. Many anesthesia policies list qualifying conditions. If those conditions were documented but not reported on the anesthesia claim, add them and send a corrected claim.

Where is the policy reference?

The usage note points to the 835 Healthcare Policy Identification segment. If the payer included a policy ID there, use it to find the exact rule.