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CO-292 Denial Code: Medical Plan Forwarded Claim to Pharmacy

CO-292 means the patient's medical plan found no benefit for the billed service, usually a drug or supply covered under the pharmacy benefit, and forwarded the claim to the patient's pharmacy plan. Follow up with the pharmacy plan before billing anyone.

Quick facts

Code
CO-292 (CARC 292)
Status
Active In use since November 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The medical plan pays nothing; the amount isn't billable to the patient while the pharmacy plan considers it.
  • OA (Other Adjustment): Some payers use OA because the claim is moving between benefits rather than being denied outright.
Official description
Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's pharmacy plan for further consideration.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-292 means

CARC 292 says the claim was received by the medical plan, but benefits are not available under this plan, and the claim has been forwarded to the patient’s pharmacy plan. It typically involves a drug, and sometimes a supply, that the plan covers through its pharmacy benefit rather than its medical benefit.

X12’s note says to use CARC 280 when the claim is not forwarded. With CO-292, the medical plan has sent it along, and the pharmacy plan will decide what happens next.

This code creates a practical problem for many practices. Pharmacy benefits are usually billed by pharmacies, at the point of dispensing, using NCPDP transactions. A clinic that purchased a drug and administered it (“buy and bill”) may have no contract or billing channel with the pharmacy benefit manager. Whether the forwarded claim can actually be paid to the practice depends on the plan.

Common causes

  • Self-administered drugs billed on a medical claim, such as drugs the plan expects patients to fill at a pharmacy.
  • Specialty drugs the plan requires to be dispensed by a designated specialty pharmacy (“white bagging”).
  • Plan designs that shift certain drug classes from the medical to the pharmacy benefit.
  • Supplies, such as some diabetic supplies, covered under pharmacy for that plan.

How to handle it

  1. Hold the balance and don’t bill the patient yet.
  2. Contact the plan to confirm the forwarded claim’s status and whether your practice can be paid through the pharmacy benefit.
  3. If it can’t, ask whether the medical plan will make an exception, for example for urgent administration, and appeal with documentation if so.
  4. Review the NDC and units on the claim; errors can prevent pharmacy processing.
  5. Decide on patient billing only after the pharmacy plan responds and you’ve checked your agreements.

How to prevent problems

  • Verify the benefit channel (medical or pharmacy) for high-cost drugs before ordering or administering.
  • Use specialty pharmacy sourcing when the plan requires it.
  • Request prior authorization under the correct benefit.
  • Include NDC data on drug lines. A Claims Validator check can confirm NDC formatting before submission.

Specialty notes

Oncology, rheumatology, dermatology, and neurology practices that administer biologics see CO-292 most. Behavioral health practices administering long-acting injectable medications may also encounter it, depending on the plan’s benefit design.

Remark codes that may appear with CO-292

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan documents that assign this drug or supply to the pharmacy benefit.
  • M119 (Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).): The NDC is missing, invalid, or deactivated, which can complicate a pharmacy review.
  • CO-280 (Claim received by the medical plan, but benefits not available under this plan.): Same outcome, but the claim wasn't forwarded; submit to the pharmacy plan yourself.
  • CO-291 (Claim received by the medical plan, but benefits not available under this plan.): The medical plan forwarded the claim to the dental plan instead.
  • CO-96 (Non-covered charge(s).): Non-covered charge, a general denial without routing.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): Not covered under the current benefit plan.

CO-292 FAQ

Why would a medical plan send a drug claim to pharmacy?

Many plans cover self-administered drugs, and sometimes specialty drugs, only under the pharmacy benefit, often through a pharmacy benefit manager or a designated specialty pharmacy. When a practice bills those drugs on a medical claim, the medical plan may route them to pharmacy.

Can my practice be paid by the pharmacy plan?

Only if you can bill it. Pharmacy claims are typically submitted in NCPDP format by a contracted pharmacy. A physician practice that bought and administered the drug may not be able to receive payment from the pharmacy benefit, so ask the plan how it handles forwarded claims.

What should I do before administering a drug next time?

Check whether the drug is covered under the medical or the pharmacy benefit for that patient's plan, and whether the plan requires it to come from a specialty pharmacy.

Should I resubmit to the pharmacy plan?

Check status first. X12 uses CARC 292 only for forwarded claims; resubmitting without checking can create duplicates.