CO-50 | Non-covered services
This code indicates that the billed service is not covered under the patient’s insurance plan benefits.
What This Code Means
CO-50 is used when an insurer determines that a specific service, procedure, or supply is excluded from coverage under the terms of the patient’s health plan. The denial is based on benefit design rather than billing format or processing errors. It reflects a contractual coverage limitation, not a mistake in claim submission. The presence of this code does not automatically imply the service was unnecessary or improperly provided. It also does not indicate that the claim was incomplete or incorrectly coded.
Where Users Usually See This Code
- Explanation of Benefits (EOB) statements sent to patients
- Electronic remittance advice (ERA) for providers
- Claim status details within insurer portals
Why This Code Appears
- The service is excluded under the plan’s benefit schedule
- The procedure is not covered for the patient’s plan type
- Coverage limitations apply due to policy design
What Typically Happens Next
- The charge is denied and not reimbursed by the payer
- Patient responsibility may be assigned depending on plan rules
- The claim is closed unless additional coverage applies
What This Code Is Not
- It is not a billing or coding error by the provider
- It is not a temporary processing delay
- It is not an indication of fraud or improper care
Troubleshooting Checklist
- □ Review the plan’s summary of benefits
- □ Confirm whether secondary coverage exists
- □ Contact the insurer for benefit clarification
Notes And Edge Cases
Coverage exclusions may vary between employer-sponsored, individual, and government plans. Some plans exclude certain services unless specific conditions are met. Coordination of benefits or secondary coverage may alter final responsibility. Historical coverage changes can also affect how this code appears.