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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

RARC M123 CARC CO-56 Procedure/treatment not deemed 'proven to be effective' by the payer CARC CO-151 Payer deems the information submitted doesn't support this many/frequency of services RARC N362 Number of days or units of service exceeds acceptable maximum CARC CO-57 CARC CO-153 Payer deems the information submitted does not support this dosage CARC CO-D2

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

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