CO-42 | Charges exceed provider’s contract

Industry

Healthcare

Canonical

/insurance/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.

Learn More

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Hub

Guides

The Complete Insurance Claim Denial Codes Directory (2026 Edition)

Related Codes

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

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