What does denial code CO-204 mean?

Not covered under the patient's current benefit plan. The plan does not include a benefit for this service.

How do I fix a CO-204 denial?

Verify benefits before the service. Bill the patient if they were informed and agreed in advance.

Pricing

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Claim adjustment reason code · Contractual obligation

CO-204
Not covered under the patient's current benefit plan

What CO-204 means

The plan does not include a benefit for this service.

The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.

Common causes

Service excluded from the plan

How to fix it

Verify benefits before the service
Bill the patient if they were informed and agreed in advance

Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.

Prevent it next time

Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.

Other codes

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CO-204Not covered under the patient's current benefit plan