CO-24 | Charges not covered
This code indicates that the charges are not covered under the terms of the patient’s insurance plan.
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What This Code Means
CO-24 is applied when billed charges fall outside the coverage parameters defined by the payer. This determination is based on plan design and benefit rules. It does not reflect a billing error or missing information. The service may be valid but excluded from reimbursement. Coverage exclusions vary by policy and payer.
Where Users Usually See This Code
- Explanation of Benefits documents
- Remittance advice
- Claim adjudication summaries
Why This Code Appears
- Charges are excluded under plan benefits
- Coverage limitations apply to the service
- Policy restrictions are enforced
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What Typically Happens Next
- Payment for the charges is denied
- Responsibility may transfer to the patient
- The claim line is closed
What This Code Is Not
- It is not a documentation error
- It is not a processing delay
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review plan benefit exclusions
- □ Confirm coverage criteria
- □ Check for secondary coverage
Notes And Edge Cases
Some plans cover charges only under specific conditions. Secondary insurance may alter final responsibility.
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Related Codes
- CO-204 CodeService not covered under plan
- CO-50 CodeNon-covered services
- CO-96 CodeNon-covered charge(s)
- CO-97 CodeBenefit not covered
- CO-200 CodeNon-covered service
- CO-31 CodePatient cannot be identified
- CO-61 CodeProcedure not covered for age
- CO-11 CodeDiagnosis inconsistent with procedure