Healthcare Error Code
Healthcare Insurance / Medical Billing
Common Medicaid / Commercial
CO-42 | Charges exceed provider’s contract
Industry
Healthcare
Canonical
/healthcare/error-codes/co-42/
Last Updated
Feb 25, 2026
Summary
This code indicates that the billed charges exceed the amount allowed under the provider’s contract.
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What This Code Means
CO-42 is used when charges exceed contractual payment limits. The adjustment reflects agreed reimbursement rates. It is not a coverage denial or billing error. Contractual limits cap allowable charges.
Where Users Usually See This Code
- Remittance advice
- Contractual adjustment summaries
- EOB explanations
Why This Code Appears
- Billed charges exceed contract rates
- Contractual fee schedules applied
- Payment caps enforced
What Typically Happens Next
- Payment is reduced to contract amount
- Claim processing completes
- Balances are adjusted
What This Code Is Not
- It is not patient responsibility
- It is not a documentation error
- It is not a duplicate claim
Troubleshooting Checklist
- □ Review contract fee schedules
- □ Monitor contractual adjustments
- □ Reconcile allowed amounts
Notes And Edge Cases
Contract terms vary by payer. Fee schedule updates may affect adjustment amounts.
Related Codes
8 links
- CO-45 CodeCharge exceeds fee schedule
- CO-131 CodeClaim-specific negotiated discount
- CO-151 CodePayment adjusted due to contractual agreement
- CO-128 CodeInvalid billing modifier
- CO-54 CodeMultiple physicians not allowed
- CO-96 CodeNon-covered charge(s)
- CO-200 CodeNon-covered service
- CO-24 CodeCharges not covered
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