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CO-P22 Denial Code: Adjusted Under MPC or PIP Rules

CO-P22 means an auto insurer adjusted, rather than fully denied, payment based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) jurisdictional regulations or payment policies. Part of the bill was paid; the regulation cited explains the reduction.

Quick facts

Code
CO-P22 (CARC P22)
Status
Active In use since November 1, 2013; last modified March 1, 2018.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The reduction is the provider's under state no-fault rules, which often bar billing the claimant for it.
  • PR (Patient Responsibility): Used when the carrier indicates the patient owes part of the amount, for example a policy deductible or co-payment under PIP. Check state rules before billing.
Official description
Payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-P22 means

CARC P22 says payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) benefits jurisdictional regulations, or payment policies. X12 limits it to property and casualty auto claims. It replaced deactivated CARC Y2.

Where CO-P21 is a full denial, CO-P22 is a partial reduction. The auto carrier accepted the bill but paid less than billed for a reason tied to no-fault rules or its payment policies, not simply a fee schedule (that’s CO-P23).

Typical reasons include an independent medical exam or utilization review that limited treatment, apportionment between accident-related and unrelated conditions, frequency limits, or policy terms such as deductibles or co-payments on PIP benefits.

Common causes

  • Utilization review or IME findings limiting the treatment the carrier will pay for.
  • Apportionment of care between accident injuries and pre-existing or unrelated conditions.
  • Frequency or duration limits under state rules or carrier policies.
  • PIP deductibles or co-payments set in the policy.
  • Remaining benefits smaller than the bill.

How to fix it

  1. Read the remark codes and cited regulation to identify the reason.
  2. Get the IME or utilization review report if one was used.
  3. Request reconsideration with records supporting the treatment and its relation to the accident.
  4. Use the state’s dispute process within its deadlines.
  5. Bill secondary coverage, often the health plan, for any remaining amount if allowed.
  6. Check state rules before billing the claimant for any PR amount.

How to prevent problems

  • Document the connection between treatment and the accident at each visit.
  • Track remaining PIP benefits and any IME dates.
  • Keep treatment within state guidelines, or get approval for more.

Specialty notes

Chiropractic and PT practices treating auto injuries often see CO-P22 after an IME recommends ending or reducing care. Tracking IME outcomes helps avoid providing treatment that won’t be paid.

Remark codes that may appear with CO-P22

  • N591 (Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).): Payment is based on an independent medical exam or utilization review.
  • N597 (Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.): Adjusted based on a provider's apportionment of care between related and unrelated conditions.
  • N640 (Exceeds number/frequency approved/allowed within time period.): Exceeds the number or frequency allowed in a time period.
  • CO-Y2Deactivated (Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)): The deactivated code that CARC P22 replaced.
  • CO-P21 (Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP)): Payment denied, rather than adjusted, under MPC or PIP rules.
  • CO-P23 (Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)): An MPC or PIP fee schedule adjustment, used when the reduction is pricing.
  • CO-P13 (Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable.): The workers' comp equivalent for reductions under jurisdictional regulations.

CO-P22 FAQ

How is CO-P22 different from CO-P23?

CO-P23 is specifically a fee schedule pricing reduction. CO-P22 covers other reductions under MPC or PIP rules, such as utilization review limits, apportionment, or frequency rules.

Can I dispute CO-P22?

Yes. Request reconsideration with documentation, then use the state's no-fault dispute process, which in some states is arbitration.

Where does the carrier cite the rule?

At claim level, in the 835 insurance policy number segment (loop 2100 REF, qualifier IG). At line level, in the healthcare policy identification segment (loop 2110 REF), when regulations apply.

Is CO-P22 used outside auto claims?

No. X12 limits it to property and casualty auto claims.

Should I keep treating after a CO-P22 reduction?

That's a clinical decision, but the patient should know that the auto carrier may not pay for further treatment of the same kind. Discuss other coverage and costs before continuing.