Claim Adjustment Reason Codes (CARC)

Claim Adjustment Reason Codes explain why a payer paid a claim or service line differently than it was billed. On an ERA they appear with a group code, such as CO-45 or PR-1. Select a code for its meaning, common causes, and how to fix it.

407 codes · Source: X12 Claim Adjustment Reason Codes, retrieved September 25, 2026

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Numeric reason codes

PR-1 Deductible Amount
PR-2 Coinsurance Amount
PR-3 Co-payment Amount
CO-4 The procedure code is inconsistent with the modifier used.
CO-5 The procedure code/type of bill is inconsistent with the place of service.
CO-6 The procedure/revenue code is inconsistent with the patient's age.
CO-7 The procedure/revenue code is inconsistent with the patient's gender.
CO-8 The procedure code is inconsistent with the provider type/specialty (taxonomy).
CO-9 The diagnosis is inconsistent with the patient's age.
CO-10 The diagnosis is inconsistent with the patient's gender.
CO-11 The diagnosis is inconsistent with the procedure.
CO-12 The diagnosis is inconsistent with the provider type.
CO-13 The date of death precedes the date of service.
CO-14 The date of birth follows the date of service.
CO-15 Deactivated 2018 The authorization number is missing, invalid, or does not apply to the billed services or provider.
CO-16 Claim/service lacks information or has submission/billing error(s).
CO-17 Deactivated 2009 Requested information was not provided or was insufficient/incomplete.
OA-18 Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
OA-19 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
CO-20 This injury/illness is covered by the liability carrier.
CO-21 This injury/illness is the liability of the no-fault carrier.
OA-22 This care may be covered by another payer per coordination of benefits.
OA-23 The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)
OA-24 Charges are covered under a capitation agreement/managed care plan.
CO-25 Deactivated 2008 Payment denied.
PR-26 Expenses incurred prior to coverage.
PR-27 Expenses incurred after coverage terminated.
CO-28 Deactivated 2003 Coverage not in effect at the time the service was provided.
CO-29 The time limit for filing has expired.
CO-30 Deactivated 2006 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
CO-31 Patient cannot be identified as our insured.
CO-32 Our records indicate the patient is not an eligible dependent.
CO-33 Insured has no dependent coverage.
CO-34 Insured has no coverage for newborns.
CO-35 Lifetime benefit maximum has been reached.
PR-36 Deactivated 2003 Balance does not exceed co-payment amount.
PR-37 Deactivated 2003 Balance does not exceed deductible.
CO-38 Deactivated 2013 Services not provided or authorized by designated (network/primary care) providers.
CO-39 Services denied at the time authorization/pre-certification was requested.
CO-40 Charges do not meet qualifications for emergent/urgent care.
CO-41 Deactivated 2003 Discount agreed to in Preferred Provider contract.
CO-42 Deactivated 2007 Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45)
CO-43 Deactivated 2006 Gramm-Rudman reduction.
CO-44 Prompt-pay discount.
CO-45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
CO-46 Deactivated 2003 This (these) service(s) is (are) not covered.
CO-47 Deactivated 2006 This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
CO-48 Deactivated 2003 This (these) procedure(s) is (are) not covered.
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 routine/preventive exam.
CO-50 These are non-covered services because this is not deemed a 'medical necessity' by the payer.
CO-51 These are non-covered services because this is a pre-existing condition.
CO-52 Deactivated 2006 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
CO-53 Services by an immediate relative or a member of the same household are not covered.
CO-54 Multiple physicians/assistants are not covered in this case.
CO-55 Procedure/treatment/drug is deemed experimental/investigational by the payer.
CO-56 Procedure/treatment has not been deemed 'proven to be effective' by the payer.
CO-57 Deactivated 2007 Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service,…
CO-58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
CO-59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.)
CO-60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.
CO-61 Adjusted for failure to obtain second surgical opinion
CO-62 Deactivated 2007 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
CO-63 Deactivated 2003 Correction to a prior claim.
CO-64 Deactivated 2003 Denial reversed per Medical Review.
CO-65 Deactivated 2003 Procedure code was incorrect.
PR-66 Blood Deductible.
CO-67 Deactivated 2003 Lifetime reserve days. (Handled in QTY, QTY01=LA)
CO-68 Deactivated 2003 DRG weight. (Handled in CLP12)
CO-69 Day outlier amount.
CO-70 Cost outlier - Adjustment to compensate for additional costs.
CO-71 Deactivated 2000 Primary Payer amount.
CO-72 Deactivated 2003 Coinsurance day. (Handled in QTY, QTY01=CD)
CO-73 Deactivated 2003 Administrative days.
CO-74 Indirect Medical Education Adjustment.
CO-75 Direct Medical Education Adjustment.
CO-76 Disproportionate Share Adjustment.
CO-77 Deactivated 2003 Covered days. (Handled in QTY, QTY01=CA)
CO-78 Non-Covered days/Room charge adjustment.
CO-79 Deactivated 2003 Cost Report days. (Handled in MIA15)
CO-80 Deactivated 2003 Outlier days. (Handled in QTY, QTY01=OU)
CO-81 Deactivated 2003 Discharges.
CO-82 Deactivated 2003 PIP days.
CO-83 Deactivated 2003 Total visits.
CO-84 Deactivated 2003 Capital Adjustment. (Handled in MIA)
PR-85 Patient Interest Adjustment (Use Only Group code PR)
CO-86 Deactivated 2003 Statutory Adjustment.
CO-87 Deactivated 2012 Transfer amount.
CO-88 Deactivated 2007 Adjustment amount represents collection against receivable created in prior overpayment.
CO-89 Professional fees removed from charges.
CO-90 Ingredient cost adjustment.
CO-91 Dispensing fee adjustment.
CO-92 Deactivated 2003 Claim Paid in full.
CO-93 Deactivated 2003 No Claim level Adjustments.
CO-94 Processed in Excess of charges.
CO-95 Plan procedures not followed.
CO-96 Non-covered charge(s).
CO-97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
CO-98 Deactivated 2003 The hospital must file the Medicare claim for this inpatient non-physician service.
CO-99 Deactivated 2003 Medicare Secondary Payer Adjustment Amount.
CO-100 Payment made to patient/insured/responsible party.
CO-101 Predetermination: anticipated payment upon completion of services or claim adjudication.
CO-102 Major Medical Adjustment.
CO-103 Provider promotional discount (e.g., Senior citizen discount).
CO-104 Managed care withholding.
CO-105 Tax withholding.
CO-106 Patient payment option/election not in effect.
CO-107 The related or qualifying claim/service was not identified on this claim.
CO-108 Rent/purchase guidelines were not met.
CO-109 Claim/service not covered by this payer/contractor.
CO-110 Billing date predates service date.
CO-111 Not covered unless the provider accepts assignment.
CO-112 Service not furnished directly to the patient and/or not documented.
CO-113 Deactivated 2007 Payment denied because service/procedure was provided outside the United States or as a result of war.
CO-114 Procedure/product not approved by the Food and Drug Administration.
CO-115 Procedure postponed, canceled, or delayed.
CO-116 The advance indemnification notice signed by the patient did not comply with requirements.
CO-117 Transportation is only covered to the closest facility that can provide the necessary care.
CO-118 ESRD network support adjustment.
PR-119 Benefit maximum for this time period or occurrence has been reached.
CO-120 Deactivated 2007 Patient is covered by a managed care plan.
CO-121 Indemnification adjustment - compensation for outstanding member responsibility.
CO-122 Psychiatric reduction.
CO-123 Deactivated 2007 Payer refund due to overpayment.
CO-124 Deactivated 2007 Payer refund amount - not our patient.
CO-125 Deactivated 2013 Submission/billing error(s).
PR-126 Deactivated 2008 Deductible -- Major Medical
PR-127 Deactivated 2008 Coinsurance -- Major Medical
CO-128 Newborn's services are covered in the mother's Allowance.
CO-129 Prior processing information appears incorrect.
CO-130 Claim submission fee.
CO-131 Claim specific negotiated discount.
CO-132 Prearranged demonstration project adjustment.
OA-133 The disposition of this service line is pending further review. (Use only with Group Code OA).
CO-134 Technical fees removed from charges.
CO-135 Interim bills cannot be processed.
OA-136 Failure to follow prior payer's coverage rules. (Use only with Group Code OA)
CO-137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
CO-138 Deactivated 2018 Appeal procedures not followed or time limits not met.
CO-139 Contracted funding agreement - Subscriber is employed by the provider of services.
CO-140 Patient/Insured health identification number and name do not match.
CO-141 Deactivated 2012 Claim spans eligible and ineligible periods of coverage.
PR-142 Monthly Medicaid patient liability amount.
CO-143 Portion of payment deferred.
CO-144 Incentive adjustment, e.g. preferred product/service.
CO-145 Deactivated 2008 Premium payment withholding
CO-146 Diagnosis was invalid for the date(s) of service reported.
CO-147 Provider contracted/negotiated rate expired or not on file.
CO-148 Information from another provider was not provided or was insufficient/incomplete.
CO-149 Lifetime benefit maximum has been reached for this service/benefit category.
CO-150 Payer deems the information submitted does not support this level of service.
CO-151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
CO-152 Payer deems the information submitted does not support this length of service.
CO-153 Payer deems the information submitted does not support this dosage.
CO-154 Payer deems the information submitted does not support this day's supply.
CO-155 Patient refused the service/procedure.
PR-156 Deactivated 2009 Flexible spending account payments.
CO-157 Service/procedure was provided as a result of an act of war.
CO-158 Service/procedure was provided outside of the United States.
CO-159 Service/procedure was provided as a result of terrorism.
CO-160 Injury/illness was the result of an activity that is a benefit exclusion.
CO-161 Provider performance bonus
CO-162 Deactivated 2014 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.
CO-163 Attachment/other documentation referenced on the claim was not received.
CO-164 Attachment/other documentation referenced on the claim was not received in a timely fashion.
CO-165 Deactivated 2018 Referral absent or exceeded.
CO-166 These services were submitted after this payers responsibility for processing claims under this plan ended.
CO-167 This (these) diagnosis(es) is (are) not covered.
CO-168 Deactivated 2018 Service(s) have been considered under the patient's medical plan.
CO-169 Alternate benefit has been provided.
CO-170 Payment is denied when performed/billed by this type of provider.
CO-171 Payment is denied when performed/billed by this type of provider in this type of facility.
CO-172 Payment is adjusted when performed/billed by a provider of this specialty.
CO-173 Service/equipment was not prescribed by a physician.
CO-174 Service was not prescribed prior to delivery.
CO-175 Prescription is incomplete.
CO-176 Prescription is not current.
CO-177 Patient has not met the required eligibility requirements.
CO-178 Patient has not met the required spend down requirements.
CO-179 Patient has not met the required waiting requirements.
CO-180 Patient has not met the required residency requirements.
CO-181 Procedure code was invalid on the date of service.
CO-182 Procedure modifier was invalid on the date of service.
CO-183 The referring provider is not eligible to refer the service billed.
CO-184 The prescribing/ordering provider is not eligible to prescribe/order the service billed.
CO-185 The rendering provider is not eligible to perform the service billed.
CO-186 Level of care change adjustment.
PR-187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)
CO-188 This product/procedure is only covered when used according to FDA recommendations.
CO-189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service
CO-190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
CO-191 Deactivated 2014 Not a work related injury/illness and thus not the liability of the workers' compensation carrier Note: If adjustment is at the Claim Level, the payer must…
CO-192 Non standard adjustment code from paper remittance.
CO-193 Original payment decision is being maintained.
CO-194 Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.
CO-195 Refund issued to an erroneous priority payer for this claim/service.
CO-196 Deactivated 2007 Claim/service denied based on prior payer's coverage determination.
CO-197 Precertification/authorization/notification/pre-treatment absent.
CO-198 Precertification/notification/authorization/pre-treatment exceeded.
CO-199 Revenue code and Procedure code do not match.
CO-200 Expenses incurred during lapse in coverage
PR-201 Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. (Use only with Group Code PR)
CO-202 Non-covered personal comfort or convenience services.
CO-203 Discontinued or reduced service.
PR-204 This service/equipment/drug is not covered under the patient's current benefit plan
CO-205 Pharmacy discount card processing fee
CO-206 National Provider Identifier - missing.
CO-207 National Provider identifier - Invalid format
CO-208 National Provider Identifier - Not matched.
OA-209 Per regulatory or other agreement.
CO-210 Payment adjusted because pre-certification/authorization not received in a timely fashion
CO-211 National Drug Codes (NDC) not eligible for rebate, are not covered.
CO-212 Administrative surcharges are not covered
CO-213 Non-compliance with the physician self referral prohibition legislation or payer policy.
CO-214 Deactivated 2014 Workers' Compensation claim adjudicated as non-compensable.
CO-215 Based on subrogation of a third party settlement
CO-216 Based on the findings of a review organization or the payer's findings.
CO-217 Deactivated 2014 Based on payer reasonable and customary fees.
CO-218 Deactivated 2014 Based on entitlement to benefits.
CO-219 Based on extent of injury.
CO-220 Deactivated 2014 The applicable fee schedule/fee database does not contain the billed code.
CO-221 Deactivated 2014 Claim is under investigation.
CO-222 Exceeds the contracted maximum number of hours/days/units by this provider for this period.
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 can be…
CO-224 Patient identification compromised by identity theft.
CO-225 Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)
CO-226 Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete.
CO-227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.
CO-228 Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication
PR-229 Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X.
CO-230 Deactivated 2014 No available or correlating CPT/HCPCS code to describe this service.
CO-231 Mutually exclusive procedures cannot be done in the same day/setting.
CO-232 Institutional Transfer Amount.
CO-233 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
CO-234 This procedure is not paid separately.
CO-235 Sales Tax
CO-236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according…
CO-237 Legislated/Regulatory Penalty.
PR-238 Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. (Use only with Group Code PR)
CO-239 Claim spans eligible and ineligible periods of coverage.
CO-240 The diagnosis is inconsistent with the patient's birth weight.
CO-241 Low Income Subsidy (LIS)
CO-242 Services not provided by network/primary care providers.
CO-243 Services not authorized by network/primary care providers.
CO-244 Deactivated 2014 Payment reduced to zero due to litigation.
CO-245 Provider performance program withhold.
CO-246 This non-payable code is for required reporting only.
PR-247 Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
PR-248 Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
CO-249 This claim has been identified as a readmission. (Use only with Group Code CO)
CO-250 The attachment/other documentation that was received was the incorrect attachment/document.
CO-251 The attachment/other documentation that was received was incomplete or deficient.
CO-252 An attachment/other documentation is required to adjudicate this claim/service.
CO-253 Sequestration - reduction in federal payment
CO-254 Claim received by the dental plan, but benefits not available under this plan.
OA-255 Deactivated 2014 The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. (Use only with Group Code OA)
CO-256 Service not payable per managed care contract.
OA-257 The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements.
CO-258 Claim/service not covered when patient is in custody/incarcerated.
CO-259 Additional payment for Dental/Vision service utilization.
CO-260 Processed under Medicaid ACA Enhanced Fee Schedule
CO-261 The procedure or service is inconsistent with the patient's history.
CO-262 Adjustment for delivery cost.
CO-263 Adjustment for shipping cost.
CO-264 Adjustment for postage cost.
CO-265 Adjustment for administrative cost.
CO-266 Adjustment for compound preparation cost.
CO-267 Claim/service spans multiple months.
CO-268 The Claim spans two calendar years.
CO-269 Anesthesia not covered for this service/procedure.
CO-270 Claim received by the medical plan, but benefits not available under this plan.
OA-271 Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when deferred amounts have been previously…
CO-272 Coverage/program guidelines were not met.
CO-273 Coverage/program guidelines were exceeded.
CO-274 Fee/Service not payable per patient Care Coordination arrangement.
PR-275 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)
CO-276 Services denied by the prior payer(s) are not covered by this payer.
OA-277 The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements.
CO-278 Performance program proficiency requirements not met. (Use only with Group Codes CO or PI)
CO-279 Services not provided by Preferred network providers.
CO-280 Claim received by the medical plan, but benefits not available under this plan.
CO-281 Deductible waived per contractual agreement.
CO-282 The procedure/revenue code is inconsistent with the type of bill.
CO-283 Attending provider is not eligible to provide direction of care.
CO-284 Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services.
CO-285 Appeal procedures not followed
CO-286 Appeal time limits not met
CO-287 Referral exceeded
CO-288 Referral absent
CO-289 Services considered under the dental and medical plans, benefits not available.
CO-290 Claim received by the dental plan, but benefits not available under this plan.
CO-291 Claim received by the medical plan, but benefits not available under this plan.
CO-292 Claim received by the medical plan, but benefits not available under this plan.
CO-293 Payment made to employer.
CO-294 Payment made to attorney.
CO-295 Pharmacy Direct/Indirect Remuneration (DIR)
CO-296 Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider.
CO-297 Claim received by the medical plan, but benefits not available under this plan.
CO-298 Claim received by the medical plan, but benefits not available under this plan.
CO-299 The billing provider is not eligible to receive payment for the service billed.
CO-300 Claim received by the Medical Plan, but benefits not available under this plan.
CO-301 Claim received by the Medical Plan, but benefits not available under this plan.
CO-302 Precertification/notification/authorization/pre-treatment time limit has expired.
CO-303 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered for Qualified Medicare and Medicaid Beneficiaries. (Use…
CO-304 Claim received by the medical plan, but benefits not available under this plan.
CO-305 Claim received by the medical plan, but benefits not available under this plan.
CO-306 Type of bill is inconsistent with the patient status.
CO-307 Medicare Maximum Fair Price Standard Default Refund Amount Adjustment.
CO-308 Payment is adjusted due to contracted funding agreement between the payer and provider.

A reason codes

CO-A0 Patient refund amount.
CO-A1 Claim/Service denied.
CO-A2 Deactivated 2008 Contractual adjustment.
CO-A3 Deactivated 2003 Medicare Secondary Payer liability met.
CO-A4 Deactivated 2008 Medicare Claim PPS Capital Day Outlier Amount.
CO-A5 Medicare Claim PPS Capital Cost Outlier Amount.
CO-A6 Prior hospitalization or 30 day transfer requirement not met.
CO-A7 Deactivated 2015 Presumptive Payment Adjustment
CO-A8 Ungroupable DRG.

B reason codes

CO-B1 Non-covered visits.
CO-B2 Deactivated 2003 Covered visits.
CO-B3 Deactivated 2003 Covered charges.
CO-B4 Late filing penalty.
CO-B5 Deactivated 2016 Coverage/program guidelines were not met or were exceeded.
CO-B6 Deactivated 2006 This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty.
CO-B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service.
CO-B8 Alternative services were available, and should have been utilized.
CO-B9 Patient is enrolled in a Hospice.
CO-B10 Allowed amount has been reduced because a component of the basic procedure/test was paid.
CO-B11 The claim/service has been transferred to the proper payer/processor for processing.
CO-B12 Services not documented in patient's medical records.
CO-B13 Previously paid.
CO-B14 Only one visit or consultation per physician per day is covered.
CO-B15 This service/procedure requires that a qualifying service/procedure be received and covered.
CO-B16 'New Patient' qualifications were not met.
CO-B17 Deactivated 2006 Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription…
CO-B18 Deactivated 2009 This procedure code and modifier were invalid on the date of service.
CO-B19 Deactivated 2003 Claim/service adjusted because of the finding of a Review Organization.
CO-B20 Procedure/service was partially or fully furnished by another provider.
CO-B21 Deactivated 2003 The charges were reduced because the service/care was partially furnished by another physician.
CO-B22 This payment is adjusted based on the diagnosis.
CO-B23 Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.

D reason codes

CO-D1 Deactivated 2003 Claim/service denied.
CO-D2 Deactivated 2003 Claim lacks the name, strength, or dosage of the drug furnished.
CO-D3 Deactivated 2003 Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing.
CO-D4 Deactivated 2003 Claim/service does not indicate the period of time for which this will be needed.
CO-D5 Deactivated 2003 Claim/service denied.
CO-D6 Deactivated 2003 Claim/service denied.
CO-D7 Deactivated 2003 Claim/service denied.
CO-D8 Deactivated 2003 Claim/service denied.
CO-D9 Deactivated 2003 Claim/service denied.
CO-D10 Deactivated 2003 Claim/service denied.
CO-D11 Deactivated 2003 Claim lacks completed pacemaker registration form.
CO-D12 Deactivated 2003 Claim/service denied.
CO-D13 Deactivated 2003 Claim/service denied.
CO-D14 Deactivated 2003 Claim lacks indication that plan of treatment is on file.
CO-D15 Deactivated 2003 Claim lacks indication that service was supervised or evaluated by a physician.
CO-D16 Deactivated 2007 Claim lacks prior payer payment information.
CO-D17 Deactivated 2007 Claim/Service has invalid non-covered days.
CO-D18 Deactivated 2007 Claim/Service has missing diagnosis information.
CO-D19 Deactivated 2007 Claim/Service lacks Physician/Operative or other supporting documentation
CO-D20 Deactivated 2007 Claim/Service missing service/product information.
CO-D21 Deactivated 2007 This (these) diagnosis(es) is (are) missing or are invalid
CO-D22 Deactivated 2009 Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be…
CO-D23 Deactivated 2012 This dual eligible patient is covered by Medicare Part D per Medicare Retro-Eligibility.

P reason codes

CO-P1 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.
CO-P2 Not a work related injury/illness and thus not the liability of the workers' compensation carrier
PR-P3 Workers' Compensation case settled.
CO-P4 Workers' Compensation claim adjudicated as non-compensable.
CO-P5 Based on payer reasonable and customary fees.
CO-P6 Based on entitlement to benefits.
CO-P7 The applicable fee schedule/fee database does not contain the billed code.
CO-P8 Claim is under investigation.
CO-P9 No available or correlating CPT/HCPCS code to describe this service.
CO-P10 Payment reduced to zero due to litigation.
OA-P11 The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation.
CO-P12 Workers' compensation jurisdictional fee schedule adjustment.
CO-P13 Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable.
CO-P14 The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day.
CO-P15 Workers' Compensation Medical Treatment Guideline Adjustment.
CO-P16 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
CO-P17 Referral not authorized by attending physician per regulatory requirement.
CO-P18 Procedure is not listed in the jurisdiction fee schedule.
CO-P19 Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due.
CO-P20 Service not paid under jurisdiction allowed outpatient facility fee schedule.
CO-P21 Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP)
CO-P22 Payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP)
CO-P23 Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)
CO-P24 Payment adjusted based on Preferred Provider Organization (PPO).
CO-P25 Payment adjusted based on Medical Provider Network (MPN).
CO-P26 Payment adjusted based on Voluntary Provider network (VPN).
CO-P27 Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies.
CO-P28 Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies.
CO-P29 Liability Benefits jurisdictional fee schedule adjustment.
CO-P30 Payment denied for exacerbation when supporting documentation was not complete.
CO-P31 Payment denied for exacerbation when treatment exceeds time allowed.
CO-P32 Payment adjusted due to Apportionment.

W reason codes

CO-W1 Deactivated 2014 Workers' compensation jurisdictional fee schedule adjustment.
CO-W2 Deactivated 2014 Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable.
CO-W3 Deactivated 2014 The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day.
CO-W4 Deactivated 2014 Workers' Compensation Medical Treatment Guideline Adjustment.
CO-W5 Deactivated 2014 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. (Use with Group Code CO or OA)
CO-W6 Deactivated 2014 Referral not authorized by attending physician per regulatory requirement.
CO-W7 Deactivated 2014 Procedure is not listed in the jurisdiction fee schedule.
CO-W8 Deactivated 2014 Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due.
CO-W9 Deactivated 2014 Service not paid under jurisdiction allowed outpatient facility fee schedule.

Y reason codes

CO-Y1 Deactivated 2014 Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)
CO-Y2 Deactivated 2014 Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)
CO-Y3 Deactivated 2014 Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)