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CO-47 Denial Code (Deactivated): Diagnosis Not Covered

CO-47 meant a diagnosis on the claim was not covered, was missing, or was invalid. X12 deactivated it without a single named replacement; payers now use CARC 167 for non-covered diagnoses and CARC 16 or 146 for missing or invalid ones.

X12 deactivated CARC47 on February 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-47 (CARC 47)
Status
Deactivated StoppedFebruary 1, 2006 (in use since January 1, 1995).
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The provider was responsible for correcting or absorbing the diagnosis-related denial.
Official description
This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-47 meant

CARC 47 covered three diagnosis problems at once. The diagnosis might be one the plan did not cover, the diagnosis might be missing from the claim, or the code reported might not be valid. From the ERA alone, a biller could not tell whether to fix a typo or accept a coverage decision.

What replaced it

X12 did not name one replacement, but the current code set handles each case separately:

  • CO-167 when the diagnosis is not covered.
  • CO-146 when the diagnosis was invalid for the date of service.
  • CO-16 with a remark code when the diagnosis is missing.

If the diagnosis is valid but does not support the service, payers use CO-11.

If you still see CO-47

It generally appears only in old remittances. A current one likely comes from a payer that has not updated its tables, and you can ask which of the three problems they meant.

To work the claim, open the encounter and compare the documented diagnoses to what was billed. Look for missing codes, codes that were deleted or not yet effective on the date of service, and codes that lack required digits. If the diagnosis was simply not covered, review the payer’s coverage policy and decide whether an appeal with documentation is worthwhile.

  • CO-167 (This (these) diagnosis(es) is (are) not covered.): The diagnosis is not covered.
  • CO-146 (Diagnosis was invalid for the date(s) of service reported.): The diagnosis was invalid for the dates of service reported.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Missing or incomplete claim information, used with a remark code for a missing diagnosis.
  • CO-11 (The diagnosis is inconsistent with the procedure.): The diagnosis is inconsistent with the procedure billed.

CO-47 FAQ

Why was CO-47 split up?

A non-covered diagnosis and a missing or invalid one call for very different actions. One may be final, the other is a data error you can correct and resubmit. Separate codes make the next step obvious.

How do I fix a claim that received CO-47?

Check that every diagnosis code is present, valid for the date of service, and coded to the required specificity, then confirm the diagnosis supports the service under the payer's policy before resubmitting.