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CO-297 Denial Code: Submit to Patient's Vision Plan

CO-297 means the patient's medical plan received the claim but has no benefits for these services, and it wants you to submit them to the patient's separate vision plan. The claim was not forwarded, so you need to bill the vision plan yourself.

Quick facts

Code
CO-297 (CARC 297)
Status
Active In use since March 1, 2019.
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 until the vision plan has been billed.
  • PR (Patient Responsibility): Sometimes used when the patient has no vision coverage for the service. Confirm there's no vision plan before billing the patient.
Official description
Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's vision plan for further consideration.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-297 means

CARC 297 says the claim was received by the medical plan, but benefits are not available under this plan; submit these services to the patient’s vision plan. The medical payer is telling you the services belong under a separate vision benefit, often administered by a different company, and it is not sending the claim there for you.

Many employers offer vision coverage as its own plan. Routine eye exams, refractions, and eyewear usually sit there, while medical eye care stays with the medical plan. When a routine service is billed to medical, CO-297 is the payer’s way of pointing you to the right place.

Its companion, CO-298, is used when the medical plan does forward the claim. The difference decides whether you need to act now or wait.

Common causes

  • Routine eye exam billed to the medical plan, with routine diagnosis codes.
  • Refraction billed to a medical plan that excludes it.
  • Eyewear or contact lenses sent to medical coverage.
  • Registration captured only the medical plan, so staff didn’t know a vision plan existed.

How to fix it

  1. Ask the patient about vision coverage and verify eligibility with the vision plan.
  2. Bill the vision plan using its required format, codes, and portal. Vision plans often use their own authorization or eligibility numbers.
  3. If the visit was medical, review the documentation. If it supports a medical diagnosis, correct box 21 and send a corrected claim to the medical plan with resubmission code 7 in box 22.
  4. Split mixed visits when the payer allows, sending routine components to vision and medical components to medical.
  5. Bill the patient only when no vision coverage applies.

How to prevent it

  • Collect both medical and vision plan details at registration.
  • Decide at scheduling whether the visit is routine or medical, and verify the right plan.
  • Know which services each vision plan covers, including frequency limits for exams and eyewear.
  • Scrub routine diagnosis codes on medical claims. A Claims Validator can flag them before submission.

Specialty notes

Optometry and ophthalmology practices see CO-297 regularly. Practices that do both routine and medical eye care benefit from a clear rule for when a visit converts from routine to medical, documented in the chart.

Remark codes that may appear with CO-297

  • N429 (Not covered when considered routine.): Not covered when considered routine, common with routine eye exams on medical plans.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to medical plan documents that exclude routine vision care.
  • CO-298 (Claim received by the medical plan, but benefits not available under this plan.): Same outcome, but the medical plan forwarded the claim to the vision plan for you.
  • CO-49 (This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a…): Non-covered routine or preventive exam, a medical plan denial without vision routing.
  • CO-304 (Claim received by the medical plan, but benefits not available under this plan.): The medical plan wants the services submitted to the hearing plan instead.
  • CO-109 (Claim/service not covered by this payer/contractor.): The claim belongs with another payer.

CO-297 FAQ

What services lead to CO-297?

Usually routine vision care, such as routine eye exams, refraction, eyeglasses, or contact lenses, billed to a medical plan that leaves those services to a separate vision benefit.

How is CO-297 different from CO-298?

CO-297 asks you to submit the claim to the vision plan yourself. CO-298 means the medical plan already forwarded it. With CO-297, nothing will happen until you send it.

What if the eye exam was for a medical problem?

Exams for medical conditions, such as eye infections, injuries, glaucoma, or diabetic eye disease, are often covered by medical plans. If documentation supports a medical reason, correct the diagnosis coding and resubmit or appeal to the medical plan.

What if the patient has no vision plan?

Confirm with the patient and the payer. If there's no vision coverage, the service may be the patient's responsibility under your financial policy.