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CO-273 Denial Code: Coverage or Program Guidelines Exceeded

CO-273 means the services exceeded the payer's coverage or program guidelines, such as a visit, unit, quantity, or time limit. Check the count the payer used, whether an extension or exception was available, and who is responsible for the excess.

Quick facts

Code
CO-273 (CARC 273)
Status
Active In use since November 1, 2015.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The provider absorbs the excess unless an exception is approved or the denial is overturned.
  • PR (Patient Responsibility): Used when the patient is liable for services beyond the limit, typically after being informed in advance. The patient may then be billed.
Official description
Coverage/program guidelines were exceeded.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-273 means

CARC 273 says coverage or program guidelines were exceeded. The service would have been covered, but it went past a limit set by the plan or program. Limits come in many forms: visits per year, units per day, quantity per month, rental months, hours of service per week, or a maximum duration of treatment.

CARC 273 is the “exceeded” half of what used to be a combined code (B5); CO-272 covers requirements not met. With CO-273, the question isn’t whether the service qualified, but how much of it the program will pay for.

Example: a Medicaid program allows a set number of therapy hours per week under a waiver. The provider bills more hours than approved, and the excess hours come back CO-273 with a remark such as N362.

Common causes

  • Visit or session caps reached for the benefit period.
  • Unit or quantity limits exceeded on a single date or over a period.
  • Program hour limits in waiver, home care, or community services programs.
  • DME rental or replacement limits exceeded.
  • Services from multiple providers counted together toward the same limit.
  • No extension requested before continuing services.

How to fix it

  1. Confirm the limit and how the payer counts it (per provider, per patient, per period).
  2. Ask for the payer’s count of services toward the limit and check for errors.
  3. Request an exception or extension where available, with documentation of medical necessity.
  4. Appeal if the count was wrong or an exception should have applied.
  5. Correct units if they were overstated, and send a corrected claim with resubmission code 7 in box 22.
  6. Bill the patient only when the payer reports PR or a valid advance agreement exists.

How to prevent it

  • Track utilization against limits for each patient, including services from other providers where visible.
  • Request extensions before the limit is reached.
  • Tell patients when they’re approaching a limit and what happens after.
  • Check units before submission. A Claims Validator can flag units over known payer limits. See MUE denials and units of service for related unit edits.

Specialty notes

PT/OT/speech practices and behavioral health providers often face visit or hour limits. DME suppliers see CO-273 with quantity and rental limits. Home and community-based services programs commonly authorize a set number of hours that can’t be exceeded without a new approval.

Remark codes that may appear with CO-273

  • N362 (The number of Days or Units of Service exceeds our acceptable maximum.): The number of days or units of service exceeds the payer's acceptable maximum.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan documents describing the limit.
  • N370 (Billing exceeds the rental months covered/approved by the payer.): Billing exceeds the rental months covered or approved by the payer, a DME example.
  • CO-272 (Coverage/program guidelines were not met.): Guidelines weren't met at all, rather than exceeded.
  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): Benefit maximum for the time period or occurrence has been reached.
  • CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): Information doesn't support this many services or this frequency.
  • CO-198 (Precertification/notification/authorization/pre-treatment exceeded.): Authorization exceeded, when services went beyond the approved number.

CO-273 FAQ

How is CO-273 different from CO-119?

CO-119 is specifically about a benefit maximum for a time period or occurrence, such as an annual visit limit. CO-273 is broader, covering any coverage or program guideline that was exceeded, including quantity, duration, or program-specific caps.

Can the limit be extended?

Some payers and programs allow extensions or exceptions with documentation of medical necessity, often through a prior authorization request. Check the program's rules.

What if the payer counted wrong?

Ask for the list of services it counted toward the limit. Services from other providers, denied claims, or duplicates are sometimes included by mistake.

Can I bill the patient for CO-273?

Only when the payer reports PR or the patient agreed in advance, as the payer's rules allow.