Skip to main content

CO-274 Denial Code: Not Payable Under Care Coordination

CO-274 means the fee or service isn't payable because of a patient care coordination arrangement, such as a medical home, care management, or similar program where the service is paid another way or reserved for a designated provider.

Quick facts

Code
CO-274 (CARC 274)
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 can't bill the patient; the service is handled under the care coordination arrangement.
  • OA (Other Adjustment): Some payers use OA when the amount is simply accounted for by the arrangement, with no responsibility assigned.
Official description
Fee/Service not payable per patient Care Coordination arrangement.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-274 means

CARC 274 says the fee or service is not payable per the patient’s care coordination arrangement. Many payers run programs where one provider or organization is responsible for coordinating a patient’s care. Those programs change how certain services are paid. A care management fee might be paid monthly to the designated practice rather than per claim, or care coordination services might be payable only to the designated provider.

When a claim conflicts with those terms, the payer denies it with CO-274. The service may be real and valuable, but under the arrangement it’s either already paid or not payable to the provider who billed it.

Common causes

  • Care management services billed by a practice that isn’t the patient’s designated care coordinator.
  • Services included in a monthly program fee billed separately on a claim.
  • Two providers billing care coordination for the same patient and period.
  • Patient enrollment in a program the billing practice didn’t know about.
  • Program ended or changed, while billing continued under old rules.

How to fix it

  1. Ask the payer which program the patient is enrolled in and who the designated provider is.
  2. Check your contract or program agreement for which services are included in the program fee.
  3. If your practice is the designated provider and the service should be paid separately, request reprocessing citing the agreement.
  4. If another practice is designated, coordinate care with them and stop billing the program services.
  5. If enrollment information is wrong, work with the payer to correct it, then ask for reprocessing.

How to prevent it

  • Verify program enrollment during eligibility checks, where payers report it.
  • Keep a list of program fees and included services for each care coordination agreement.
  • Confirm designation before starting care management services for a new patient.
  • Track program payments separately. An ERA Analyzer can separate program-related adjustments from denials.

Specialty notes

Primary care practices in medical home programs, behavioral health homes, and practices billing care management services see CO-274 most. Specialists who begin care management for patients already enrolled with a primary care medical home should confirm the payer’s rules first.

Remark codes that may appear with CO-274

  • N381 (Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.): Directs you to the contract terms governing the arrangement.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan documents describing the program.
  • OA-24 (Charges are covered under a capitation agreement/managed care plan.): Covered under a capitation agreement, another payment arrangement that replaces fee-for-service.
  • CO-256 (Service not payable per managed care contract.): Service not payable per the managed care contract.
  • CO-242 (Services not provided by network/primary care providers.): Services not provided by the network or primary care provider.
  • CO-B20 (Procedure/service was partially or fully furnished by another provider.): The service was partially or fully furnished by another provider.

CO-274 FAQ

What is a care coordination arrangement?

A program in which a designated provider or organization manages the patient's care, such as a patient-centered medical home, a health home, or a care management program. Some services are paid through a per-member fee or reserved for the designated provider.

Why was my care management service denied?

Another provider may already be paid to coordinate care for the patient in the same period, or the payer includes that service in the program's fee rather than paying it per claim.

How do I respond to CO-274?

Find out which program the patient is enrolled in and who the designated provider is. If your practice is the designated provider, check whether the service is included in the program fee. If you aren't, coordinate with that provider.

Is the patient ever billed?

Generally no. The denial reflects an arrangement between the payer and providers, not a patient cost-sharing rule.