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CO-P25 Denial Code: Adjusted per Medical Provider Network

CO-P25 means a property and casualty payer adjusted payment based on a Medical Provider Network (MPN). The carrier applied network terms, such as a contracted rate, because the service falls under an MPN arrangement the provider participates in or the claim is governed by.

Quick facts

Code
CO-P25 (CARC P25)
Status
Active In use since November 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The only group allowed for P25. The adjustment is contractual, and the injured person isn't billed for it.
Official description
Payment adjusted based on Medical Provider Network (MPN). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). 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 only. (Use only with Group Code CO).
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-P25 means

CARC P25 says payment adjusted based on Medical Provider Network (MPN). X12 limits it to property and casualty claims and requires group code CO.

Some states let employers and workers’ compensation insurers set up Medical Provider Networks. When an MPN applies, injured workers usually get treatment from network providers, and those providers are paid under network contract terms. The carrier reports the resulting adjustment as CO-P25.

The usage note tells you where to find the contract basis: at claim level in the 835 class of contract code segment (loop 2100 REF), and at line level in the healthcare policy identification segment (loop 2110 REF), when regulations apply.

This is related to CO-P24 (PPO) and CO-P26 (Voluntary Provider Network). The difference is the type of network, which matters because each has different rules about who can treat and how rates are set.

Common causes

  • MPN contract rate lower than the state fee schedule or your charge.
  • Network status that determines which rate applies.
  • Wrong network or contract matched to your tax ID.
  • Terminated network participation still applied by the carrier.

How to handle it

  1. Confirm your MPN participation and the contract terms.
  2. Identify the contract referenced in the 835 REF segments.
  3. Compare the payment to your MPN rate and any state rules that limit network pricing.
  4. Post valid adjustments as contractual. Don’t bill the injured worker.
  5. Dispute incorrect rates or contracts with the carrier or network administrator.

How to prevent problems

  • Keep a record of every MPN you belong to, including effective dates and rates.
  • Verify the injured worker’s MPN before the first visit.
  • Update the network when your locations, providers, or tax ID change.
  • Monitor network adjustments. An ERA Analyzer can surface CO-P25 amounts by carrier for comparison with your contract.

Specialty notes

Occupational medicine, orthopedic, and PT practices in states with MPNs should confirm network status for each injured worker, since treating outside the network can lead to denials.

Remark codes that may appear with CO-P25

  • N381 (Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.): Directs you to the contractual agreement behind the network adjustment.
  • N612 (Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.): The provider isn't authorized or certified to treat injured workers in the jurisdiction, which can arise when a provider is outside the network.
  • CO-P24 (Payment adjusted based on Preferred Provider Organization (PPO).): Adjusted based on a Preferred Provider Organization arrangement.
  • CO-P26 (Payment adjusted based on Voluntary Provider network (VPN).): Adjusted based on a Voluntary Provider Network.
  • CO-P16 (Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.): Provider not authorized to treat injured workers in the jurisdiction.
  • CO-P12 (Workers' compensation jurisdictional fee schedule adjustment.): A workers' comp jurisdictional fee schedule adjustment.

CO-P25 FAQ

What is a Medical Provider Network?

A network of providers an employer or insurer sets up to treat injured workers, recognized under some states' workers' compensation laws. California is the best-known example. Injured workers covered by an MPN generally must treat within it, with exceptions.

Where does the payer identify the network terms?

At claim level, in the 835 class of contract code segment (loop 2100 REF). At line level, in the healthcare policy identification segment (loop 2110 REF), when the regulations apply.

What if I'm not in the MPN?

The carrier may deny or limit payment for treatment outside the network, depending on state rules and exceptions. Confirm network status before treating.

Is CO-P25 a denial?

Usually not. It reports a network-based adjustment to payment. Verify the rate against your network agreement.

Is CO-P25 used by health plans?

No. X12 limits it to property and casualty claims.