Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-96 | Non-covered charge(s)
Industry
Healthcare
Canonical
/healthcare/error-codes/co-96/
Last Updated
Feb 25, 2026
Summary
This code indicates that one or more billed charges are not covered under the patient’s insurance plan.
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What This Code Means
CO-96 is used when specific charges on a claim are excluded from coverage based on plan benefits. The service itself may have been validly provided, but the plan does not reimburse for that charge type. This code can apply to entire services or specific components of a billed line. It does not imply that the claim was incorrectly submitted. It also does not automatically assign fault to the provider or patient.
Where Users Usually See This Code
- Explanation of Benefits documents
- Provider remittance advice
- Claim adjudication summaries
Why This Code Appears
- The plan excludes the billed charge category
- The service exceeds coverage limitations
- Benefit restrictions apply to the charge
What Typically Happens Next
- The payer denies payment for the charge
- Responsibility may transfer to the patient
- The claim line is closed
What This Code Is Not
- It is not a coding format error
- It is not a temporary hold
- It is not related to authorization
Troubleshooting Checklist
- □ Review benefit exclusions
- □ Confirm whether appeal options exist
- □ Check for secondary coverage
Notes And Edge Cases
Some plans cover charges only when bundled with other services. Secondary insurance may change final responsibility. Coverage exclusions can vary widely by policy.
Related Codes
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