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CO-289 Denial Code: No Benefits Under Dental or Medical Plan

CO-289 means the payer considered the service under both the patient's dental plan and medical plan, and benefits aren't available under either. Unlike the 'send it to the other plan' codes, there's nowhere left within this payer to route it.

Quick facts

Code
CO-289 (CARC 289)
Status
Active In use since November 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The payer's usual group. The provider can't bill the patient on this basis unless the patient accepted financial responsibility in advance.
  • PR (Patient Responsibility): Used when the payer considers the non-covered service the patient's responsibility. You may bill the patient, following your financial agreement and any state rules.
Official description
Services considered under the dental and medical plans, benefits not available.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-289 means

CARC 289 says services considered under the dental and medical plans, benefits not available. The payer, often one company that administers both a member’s dental and medical coverage, evaluated the claim against both benefit sets and found no benefit in either.

X12 points readers to three related codes: CARC 254, CARC 270, and CARC 280. Those tell you to send the claim somewhere else. CARC 289 is the end of that road: both plans have already been considered, so the claim isn’t waiting on another review.

Example: an oral surgeon bills a procedure to the patient’s dental carrier. The dental plan excludes it as medical; the carrier’s medical side reviews it and finds it isn’t covered because the diagnosis doesn’t meet the medical policy. The remittance comes back CO-289.

Common causes

  • Crossover services that each plan classifies as belonging to the other, such as some oral surgery, orthognathic procedures, or dental implants after trauma.
  • Diagnosis not supporting medical coverage, for example a dental diagnosis on a service the medical plan covers only for specific conditions.
  • Plan exclusions for cosmetic or elective services.
  • Coding in the wrong code set, such as a CDT code where the medical plan expects CPT or HCPCS, or the reverse.
  • Missing documentation showing medical necessity.

How to fix it

  1. Read the remark codes and ask the payer which exclusion each plan applied.
  2. Review the diagnosis and code set. If the service was medically necessary, confirm a medical claim with ICD-10-CM diagnoses and medical procedure codes was actually reviewed.
  3. Correct and resubmit if the claim format or codes were wrong, using resubmission code 7 in box 22 on a CMS-1500.
  4. Appeal to the plan whose coverage best fits, with records, imaging, and a letter of medical necessity.
  5. Bill the patient only if the payer reports PR or the patient agreed in writing before treatment.

How to prevent it

  • Check both plans before treatment for procedures known to fall between dental and medical coverage.
  • Request predetermination from the dental plan and prior authorization from the medical plan when available.
  • Document medical necessity clearly for services with a medical basis.
  • Give patients a written cost estimate when coverage is uncertain.

Specialty notes

Oral and maxillofacial surgeons, dentists offering sleep apnea appliances, and practices treating TMJ disorders see this code most. Cross-coding between dental and medical code sets is a specialized skill; keep payer-specific rules on hand.

Remark codes that may appear with CO-289

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to both plans' benefit documents for the exclusion that applied.
  • N580 (Determination based on the provisions of the insurance policy.): The determination was based on the provisions of the insurance policy.
  • CO-254 (Claim received by the dental plan, but benefits not available under this plan.): The dental plan says no benefits and tells you to submit to the medical plan yourself.
  • CO-270 (Claim received by the medical plan, but benefits not available under this plan.): The medical plan says no benefits and tells you to submit to the dental plan yourself.
  • CO-290 / CO-291 (Dental-to-medical and medical-to-dental forwarding.): The plan forwarded the claim to the other plan instead of closing it out.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service isn't covered under the patient's current benefit plan, a single-plan exclusion.

CO-289 FAQ

When does CO-289 usually appear?

With services that sit on the border between dental and medical coverage, such as oral surgery, treatment after facial trauma, TMJ care, sleep apnea appliances, or some anesthesia for dental procedures. Payers that administer both plans review it under each and may conclude neither covers it.

Should I resubmit to the other plan?

Not with CO-289 alone. The code says both plans already looked at it. Resubmit only if you have new information, such as a medical diagnosis or documentation that wasn't on the original claim.

Can I appeal CO-289?

Yes, if you believe one of the plans should cover it. Appeal to the plan whose policy best fits the service, with the diagnosis, clinical notes, and any medical necessity letter.

Does CO-289 mean the patient has no insurance?

No. It only means these particular services aren't covered under the dental or medical plan it checked. Other services, or other coverage, may still apply.