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Denial Codes

This document lists and defines common denial codes used in medical billing, including codes for when procedures are inconsistent with modifiers, diagnoses don't match procedures, claims are missing required information, claims are duplicates, expenses occurred after coverage ended, services aren't deemed medically necessary, charges are non-covered, and claims weren't submitted to the correct payer. It provides explanations for denial codes frequently encountered in medical billing.

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2K views1 page

Denial Codes

This document lists and defines common denial codes used in medical billing, including codes for when procedures are inconsistent with modifiers, diagnoses don't match procedures, claims are missing required information, claims are duplicates, expenses occurred after coverage ended, services aren't deemed medically necessary, charges are non-covered, and claims weren't submitted to the correct payer. It provides explanations for denial codes frequently encountered in medical billing.

Uploaded by

shyam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd
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CO 4 Denial Code – The procedure code is inconsistent with the modifier used or a

required modifier is missing

CO 11 Denial Code – The diagnosis is inconsistent with the procedure

CO 16 Denial Code – Claim or Service Lacks Information which is needed for


adjudication

CO 18 Denial Code – Duplicate Claim or Service

CO 22 Denial Code – This care may be covered by another payer per coordination of
benefits

CO 24 Denial Code – Charges are covered under a capitation agreement or managed


care plan

CO 27 Denial Code – Expenses incurred after coverage terminated

CO 29 Denial Code – The time limit for filing has expired

CO 50 Denial Code – These are non-covered services because this is not deemed
medical necessity by the payer

CO 96 Denial Code – Non-Covered Charges

CO 97 Denial Code – The benefit for this service is included in the payment or
allowance for another service or procedure that has already been adjudicated

CO 109 Denial Code – Claim or Service not covered by this payer or contractor, you
must send the claim or service to the correct payer or contractor

These are some of the important Denial reason codes, which we come across regularly
and it’s been explained along with solutions.

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