Skip to main content

CO-287 Denial Code: Referral Exceeded

CO-287 means the referral on file was exceeded: the service went beyond the visits, dates, or services the referral covered. The patient had a referral, but this claim falls outside it, so a new or extended referral is typically needed.

Quick facts

Code
CO-287 (CARC 287)
Status
Active In use since November 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The specialist absorbs the amount unless a valid referral is obtained or the denial is overturned.
  • PR (Patient Responsibility): Used when the patient is responsible, for example after continuing care knowing the referral had run out. Check your contract before billing.
Official description
Referral exceeded
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-287 means

CARC 287 says referral exceeded. In plans that require referrals, typically HMOs and some point-of-service and Medicaid managed care plans, the patient’s primary care provider issues a referral that allows specialist care. Referrals usually have limits: a number of visits, an expiration date, or specific services. When a claim goes beyond those limits, the payer denies it with CO-287.

It’s the counterpart to CO-288, which means no referral was on file. With CO-287, the patient had a referral; it just didn’t cover this service.

See authorization and referral denials for more on managing referral workflows.

Common causes

  • Visit count used up, such as the seventh visit on a six-visit referral.
  • Referral expired before the date of service.
  • Service outside the referral’s scope, like a procedure when the referral covered consultation only.
  • Referral to a different provider or group than the one billing.
  • Patient changed primary care providers, and the old referral no longer applies.

How to fix it

  1. Check the referral details: issuing provider, number of visits, dates, and services.
  2. Contact the primary care provider to request an extension or new referral.
  3. Ask the payer about retroactive referrals if the plan allows them.
  4. Request reprocessing once a valid referral is on file.
  5. Appeal if you have proof the referral covered the service.
  6. Write off if no referral can be obtained and CO applies.

How to prevent it

  • Track referral usage with visit counts and expiration dates in your scheduling system.
  • Request extensions before the last covered visit.
  • Verify referral scope for procedures and tests, not just office visits.
  • Recheck the primary care assignment during eligibility verification. See eligibility and COB denials.

Specialty notes

Behavioral health, PT/OT, and other specialties with recurring visits exceed referrals most often, because ongoing treatment quickly uses up a limited visit count.

Remark codes that may appear with CO-287

  • N54 (Claim information is inconsistent with pre-certified/authorized services.): The claim information is inconsistent with the authorized services.
  • N335 (Missing/incomplete/invalid referral date.): The referral date is missing, incomplete, or invalid.
  • CO-288 (Referral absent): Referral absent: no referral was on file at all.
  • CO-198 (Precertification/notification/authorization/pre-treatment exceeded.): Authorization exceeded, the same problem for prior authorizations.
  • CO-243 (Services not authorized by network/primary care providers.): Services not authorized by network or primary care providers.
  • CO-273 (Coverage/program guidelines were exceeded.): Coverage or program guidelines exceeded.

CO-287 FAQ

What's the difference between a referral and a prior authorization?

A referral is usually issued by the patient's primary care provider to allow specialist visits under an HMO or similar plan. A prior authorization is the payer's approval of a specific service. Some plans require both.

How do referrals get exceeded?

Referrals often cover a limited number of visits, a date range, or specific services. Seeing the patient more times, after the expiration date, or for a service outside the referral's scope exceeds it.

Can I get a referral backdated?

Some plans allow retroactive referrals within a short window; others don't. Contact the primary care provider and the payer promptly.

Can I bill the patient for CO-287?

Under CO, no. Many managed care contracts require the specialist to verify referrals and prohibit billing members for referral lapses.

Does the referral need to be on the claim?

Some payers require the referral number or referring provider in box 17 and 17b, or the referral number in box 23. Others track referrals electronically. Follow each payer's instructions.