CO-109 - Claim/service not covered by this payer/contractor
Contractual Obligation Feb 20, 2024
The claim or service is not covered by the payer or contractor. You must send the claim to the correct payer or contractor.
Healthcare Error Codes Directory
A reference for medical, insurance, and claim-related error codes including denial reasons, eligibility failures, and authorization codes.
Healthcare error codes are short identifiers used on claims, remittance advice, and eligibility responses to explain what happened and what needs attention next. They often point to coverage rules, documentation gaps, authorization requirements, or mismatches between the billed service and the payer’s processing logic.
This directory is built for billing teams, providers, and patients who need fast, neutral explanations without guesswork. Pages are organized by common prefixes (CO-, PR-, OA-, PI-) and the most frequently encountered denial and adjustment reasons. Each entry focuses on what the code typically means in practice and which checks usually resolve it.
- Browse codes by prefix to quickly narrow down the “type” of denial or adjustment
- Review common denial scenarios and the data elements that trigger them
- Jump to recently indexed codes to see what’s been added most recently
- Compare similar codes that look alike but require different fixes
- Use the guide and FAQ for repeatable troubleshooting steps
What you'll find here
- ✓ Denial and adjustment codes grouped by the way payers communicate decisions
- ✓ Eligibility, authorization, and documentation-related error references
- ✓ Practical next steps to fix common claim and remittance issues
- ✓ Links to the full index and the newest pages added to the directory
Recently Indexed
15 codesPR-96 - Non-covered charge(s)
Patient Responsibility Feb 18, 2024
Charges are not covered by the patient's insurance plan. These may be excluded services or procedures.
OA-23 - Payment adjusted due to procedure overlap
Other Adjustments Feb 15, 2024
The payment has been reduced because the reported procedure overlaps with another procedure on the same date of service.
PI-204 - Service not covered under patient's current benefit plan
Payer Initiated Feb 12, 2024
This service is specifically excluded from coverage under the patient's current benefit plan.
CO-197 - Precertification/authorization absent
Contractual Obligation Feb 10, 2024
Precertification, prior authorization, or referral is required but was not obtained before services were rendered.
PR-1 - Deductible amount
Patient Responsibility Feb 8, 2024
The amount applied to the patient's annual deductible. This is the patient's responsibility to pay.
CO-50 - Non-covered services because this is not deemed a 'medical necessity'
Contractual Obligation Feb 5, 2024
The service is not covered because it is not considered medically necessary by the payer's criteria.
OA-121 - Document does not meet the criteria for the service billed
Other Adjustments Feb 3, 2024
The documentation submitted does not support the level of service or procedure that was billed.
PI-97 - The benefit for this service is included in the payment for another service
Payer Initiated Feb 1, 2024
Payment for this service is bundled with another service and is not separately reimbursable.
CO-16 - Claim lacks information needed for adjudication
Contractual Obligation Jan 28, 2024
The claim is missing required information such as diagnosis codes, procedure codes, or supporting documentation.
PR-204 - This service/equipment/drug is not covered under the patient's current benefit plan
Patient Responsibility Jan 25, 2024
The specific service, equipment, or drug is excluded from coverage under the patient's benefit plan.
CO-29 - The time limit for filing has expired
Contractual Obligation Jan 22, 2024
The claim was submitted after the payer's deadline for claim submission has passed.
OA-94 - Processed in excess of charges
Other Adjustments Jan 20, 2024
The payment amount exceeds the billed charges. An adjustment is necessary to correct the overpayment.
PI-22 - Payment adjusted because this care may be covered by another payer
Payer Initiated Jan 18, 2024
Another insurance plan may be primary for this service. Coordination of benefits is required.
CO-167 - This (these) diagnosis(es) is (are) not covered
Contractual Obligation Jan 15, 2024
The diagnosis code(s) reported are not covered under the patient's benefit plan for the services billed.
Common / Featured
10 codesCO-16 - Claim lacks information needed for adjudication
Contractual Obligation ★ Featured
The claim is missing required information such as diagnosis codes, procedure codes, or supporting documentation.
PR-1 - Deductible amount
Patient Responsibility ★ Featured
The amount applied to the patient's annual deductible. This is the patient's responsibility to pay.
CO-50 - Non-covered services because this is not deemed a 'medical necessity'
Contractual Obligation ★ Featured
The service is not covered because it is not considered medically necessary by the payer's criteria.
CO-197 - Precertification/authorization absent
Contractual Obligation ★ Featured
Precertification, prior authorization, or referral is required but was not obtained before services were rendered.
PR-96 - Non-covered charge(s)
Patient Responsibility ★ Featured
Charges are not covered by the patient's insurance plan. These may be excluded services or procedures.
CO-109 - Claim/service not covered by this payer/contractor
Contractual Obligation ★ Featured
The claim or service is not covered by the payer or contractor. You must send the claim to the correct payer or contractor.
OA-23 - Payment adjusted due to procedure overlap
Other Adjustments ★ Featured
The payment has been reduced because the reported procedure overlaps with another procedure on the same date of service.
PI-97 - The benefit for this service is included in the payment for another service
Payer Initiated ★ Featured
Payment for this service is bundled with another service and is not separately reimbursable.
CO-29 - The time limit for filing has expired
Contractual Obligation ★ Featured
The claim was submitted after the payer's deadline for claim submission has passed.
PI-204 - Service not covered under patient's current benefit plan
Payer Initiated ★ Featured
This service is specifically excluded from coverage under the patient's current benefit plan.
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How to Read Healthcare Error Codes
Healthcare error codes follow standardized formats established by the healthcare industry. Understanding these patterns helps identify the root cause of claim denials and processing failures.
1. Identify the Code Type
Healthcare codes typically begin with prefixes that indicate the type of issue:
- CO-: Contractual obligations between provider and payer
- PR-: Patient responsibility amounts
- OA-: Other adjustments not covered by other categories
- PI-: Payer-initiated adjustments
- CARC: Claim Adjustment Reason Codes
2. Understand the Context
Each code includes contextual information about:
- The specific service or procedure involved
- The date of service
- The provider who submitted the claim
- The insurance company processing the claim
3. Cross-Reference with Documentation
Always verify error codes against official documentation from:
- Centers for Medicare & Medicaid Services (CMS)
- Insurance company provider manuals
- HIPAA transaction and code set standards
4. Take Action Based on Code Type
Different code types require different responses:
- Denial codes: May require claim resubmission or appeal
- Adjustment codes: Often indicate payment modifications
- Informational codes: Provide processing status updates
If You’re Stuck
Checklist for Healthcare Code Issues:
- Verify patient eligibility and coverage status
- Confirm provider credentials and network participation
- Review claim submission deadlines and requirements
- Check for missing documentation or authorization
- Contact insurance company for clarification
- Consult with billing specialist or coding expert
- Document all communications and reference numbers
- Follow up within required timeframes for appeals