Medicare denial CO codes
1 Deductible Amount.
2 Coinsurance Amount.
3 Co-Payment Amount.
4 The procedure code is inconsistent with the modifier used, or a required modifier is missing.
5 The procedure code/bill type is inconsistent with the place of service.
6 The procedure code is inconsistent with the patient’s age.
7 The procedure code is inconsistent with the patient’s sex.
8 The procedure code is inconsistent with the provider type.
9 The diagnosis is inconsistent with the patient’s age.
10 The diagnosis is inconsistent with the patient’s sex.
11 The diagnosis is inconsistent with the procedure.
12 The diagnosis is inconsistent with the provider type.
13 The date of death precedes the date of service.
14 The date of birth follows the date of service.
15 Claim/service denied because the submitted authorization number is missing, invalid, or does not apply to the billed services.
16 Claim/service lacks information which is needed for adjudication.
17 Claim/service denied because requested information was not provided or was insufficient/incomplete.
18 Duplicate claim/service.
19 Claim denied because this is a workrelated injury and thus the liability of the Worker’s Compensation Carrier.
20 Claim denied because this injury is covered by the liability carrier.
21 Claim denied because this injury is the liability of the nofault carrier.
22 Claim denied/reduced because this care may be covered by another payer per coordination of benefits.
23 Claim denied/reduced because charges have been paid by another payer as part of coordination of benefits.
24 Payment for charges denied/reduced. Charges are covered under a capitation agreement.
25 Payment denied. Your stop loss deductible has not been met. (Not Medicare)
26 Expenses incurred prior to coverage.
27 Expenses incurred after coverage terminated.
28 ÏCoverage not in effect at the time the service was provided.
29 The time limit for filing has expired.
30 Benefits are not available for these services until the patient has met the required waiting or residency period.
31 Claim denied as patient cannot be identified as our insured.
32 Our records indicate that this dependent is not an eligible dependent as defined. (Not Medicare)
33 Claim denied. Insured has no dependent coverage. (Not Medicare)
34 Claim denied. Insured has no coverage for newborns.
35 Benefit maximum has been reached.
36 *Balance does not exceed copayment amount.
37 *Balance does not exceed deductible.
38 Services not provided or authorized by designated (network) providers.
39 Services denied at the time authorization/precertification was requested.
40 Charges do not meet qualifications for emergency/urgent care outofarea.
41 *Discount agreed to in Preferred Provider contract.
42 Charges exceed our fee schedule or maximum allowable amount.
43 Gramm Rudman reduction.
44 Prompt pay discount (Not Medicare).
45 Charges exceed your contracted/legislated fee arrangement.
46 This (these) service(s) is (are) not covered.
47 This (these) diagnosis(es) is (are) not covered.
48 This (these) procedure(s) is (are) not covered.
49 These are non covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.
50 These are non covered services because this is not deemed a “medical necessity” by the payer.
Medicare denial reason code -1
Medicare denial reason code – 2
Medicare denial reason code – 3
Denial EOB
Medicare EOB
