Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-61 | Procedure not covered for age
Industry
Healthcare
Canonical
/healthcare/error-codes/co-61/
Last Updated
Feb 25, 2026
Summary
This code indicates that the procedure is not covered for the patient’s age under the payer’s policy.
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What This Code Means
CO-61 is applied when a payer determines that a procedure does not meet age-related coverage criteria. Coverage rules often include age limits for certain services. This determination is policy-based rather than a billing error. It does not imply that the procedure was inappropriate. Coverage eligibility depends on payer-defined age parameters.
Where Users Usually See This Code
- Remittance advice
- EOB statements
- Coverage determination notices
Why This Code Appears
- Patient age falls outside covered range
- Age-specific coverage limitations apply
- Payer clinical policy enforced
What Typically Happens Next
- Payment is denied
- Claim line is closed
- Responsibility may transfer per policy
What This Code Is Not
- It is not a documentation error
- It is not a duplicate claim
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review age-related coverage rules
- □ Confirm patient age data
- □ Monitor policy updates
Notes And Edge Cases
Age criteria may differ by payer and plan. Some policies allow exceptions under limited circumstances.
Related Codes
8 links
- CO-200 CodeNon-covered service
- CO-62 CodeNot covered for place of service
- CO-97 CodeBenefit not covered
- CO-204 CodeService not covered under plan
- CO-11 CodeDiagnosis inconsistent with procedure
- CO-50 CodeNon-covered services
- CO-54 CodeMultiple physicians not allowed
- CO-65 CodeProcedure code invalid
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