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CO-43 Denial Code (Deactivated): Gramm-Rudman Reduction

CO-43 identified a payment reduction made under the Gramm-Rudman federal deficit-control law. X12 deactivated it without naming a replacement. Today's comparable federal payment cut, sequestration, is reported with CARC 253.

X12 deactivated CARC43 on July 1, 2006. Payers should no longer use it on new remittances, but it can still appear on older ERAs, corrected claims, and appeals.

Quick facts

Code
CO-43 (CARC 43)
Status
Deactivated StoppedJuly 1, 2006 (in use since January 1, 1995).
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The reduction was imposed by federal law and was not billable to the patient.
Official description
Gramm-Rudman reduction.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-43 meant

CARC 43 labeled a reduction that had nothing to do with coding, coverage, or your contract. Federal deficit-control legislation known as Gramm-Rudman allowed automatic cuts to federal spending, and Medicare payments were among the items reduced. The code showed providers how much of their payment was withheld because of that law.

What replaced it

X12 did not name a successor. The closest active code in spirit is CO-253, used for sequestration reductions to federal payments under later budget legislation. For other legally mandated adjustments that do not fit a specific code, payers can use CO-223.

If you still see CO-43

This is a historical code and should only appear in very old Medicare remittance archives or in research on legacy payment data. There is nothing to correct on the claim. Post it as a non-billable adjustment and keep it separate from fee schedule write-offs such as CO-45, so your contract analysis is not distorted by a legislated cut.

If something current carries code 43, contact the payer; it may be a mapping error for sequestration.

  • CO-253 (Sequestration - reduction in federal payment): Sequestration, the current code for across-the-board federal payment reductions.
  • CO-223 (Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code…): Adjustments mandated by federal, state, or local law not covered by another code.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): Fee schedule reductions, which are separate from any legislated across-the-board cut.

CO-43 FAQ

What was Gramm-Rudman?

It refers to the Gramm-Rudman-Hollings deficit reduction legislation of the 1980s, which could trigger automatic cuts to federal spending, including Medicare payments. CO-43 labeled those cuts on remittances.

Can a CO-43 reduction be appealed?

No. It was a statutory reduction applied to payments across the board, not a decision about the individual claim.