What CO-40 means
The payer does not consider the visit an emergency or urgent care under its rules.
The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.
Common causes
- Diagnosis or documentation does not support emergency status
How to fix it
- Review the documentation and diagnosis coding
- Appeal with records showing the urgency, if supported
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.