CO-96
Non-covered charge(s)
What This Code Means
The service is specifically excluded from the patient’s benefit plan.
Common Causes
- Service falls under a plan exclusion (e.g. cosmetic, experimental)
- Benefit maximum already used for this service type
- Wrong plan/product billed
How to Resolve or Appeal
- Review the specific plan's exclusions
- Confirm the correct plan/policy number was billed
- If incorrectly denied, request the payer cite the exact exclusion language
- Bill patient per financial policy if genuinely excluded
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.