What does denial code CO-49 mean?

Routine or preventive service not covered. The service is a routine or preventive exam (or done with one) that the plan does not cover.

How do I fix a CO-49 denial?

Check preventive benefits before the visit. If a separate problem was addressed, bill it separately with modifier 25 where documented.

Pricing

Patient login Employee login

Claim adjustment reason code · Contractual obligation

CO-49
Routine or preventive service not covered

What CO-49 means

The service is a routine or preventive exam (or done with one) that the plan does not cover.

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

Common causes

Preventive service billed to a plan without that benefit
Problem-oriented visit not separated from the preventive visit

How to fix it

Check preventive benefits before the visit
If a separate problem was addressed, bill it separately with modifier 25 where documented

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

All denial codes →

Let us work your denials.

We triage every denial by code and payer, fix or appeal it, and stop it repeating.

Talk to us →Denial management service →

CO-49Routine or preventive service not covered