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CO-261 - Denial Journal
CARC CO — Contractual Obligation

CO-261

The procedure or service is inconsistent with the patient's history

What This Code Means

The billed service doesn’t align with the patient’s documented medical history on file with the payer.

Common Causes

  • New diagnosis/procedure combination not previously seen for this patient
  • History documentation not submitted with the claim

How to Resolve or Appeal

  1. Submit relevant history/documentation supporting the service
  2. Appeal if the service is clinically appropriate despite being new for this patient

More Denial Codes to Check

CARC CO-150 Payer deems the information submitted does not support this level of service RARC M123 RARC MA50 RARC N362 Number of days or units of service exceeds acceptable maximum RARC M25 Information furnished does not substantiate the need for this level of service CARC CO-50 Non-covered because not deemed a medical necessity by the payer RARC M10 RARC M42 CARC CO-D2 CARC CO-57 CARC CO-56 Procedure/treatment not deemed 'proven to be effective' by the payer CARC CO-152 Payer deems the information submitted does not support this length of service CARC CO-153 Payer deems the information submitted does not support this dosage

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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