Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-204 | Service not covered under plan
Industry
Healthcare
Canonical
/healthcare/error-codes/co-204/
Last Updated
Feb 25, 2026
Summary
This code indicates that the service is excluded from coverage under the patient’s insurance plan.
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What This Code Means
CO-204 is applied when a payer determines that a specific service is not included in the plan’s covered benefits. The denial is based on plan design rather than claim submission accuracy. It reflects an exclusion or limitation within the policy. This does not imply that the service was unnecessary or incorrectly provided. Coverage exclusions vary by plan type and policy terms.
Where Users Usually See This Code
- Explanation of Benefits documents
- Remittance advice
- Claim adjudication summaries
Why This Code Appears
- The service is excluded under plan benefits
- Coverage limits apply to the service category
- Plan design restrictions are enforced
What Typically Happens Next
- Payment for the service is denied
- Responsibility may transfer to the patient
- The claim line is closed
What This Code Is Not
- It is not a billing error
- It is not a processing delay
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review plan benefit documents
- □ Confirm coverage exclusions
- □ Check for secondary coverage options
Notes And Edge Cases
Some services may be covered only under specific circumstances. Secondary insurance may affect final responsibility.
Related Codes
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