DENIAL CODE · CO-24

CO-24: Charges Covered Under Capitation

CO-24 means the payer considers this service already paid for under a capitation or managed-care arrangement, so it won't pay fee-for-service on top. Sometimes correct — sometimes the patient wasn't actually capitated to your group.

Official (X12/WPC): "Charges are covered under a capitation agreement/managed care plan."

Written forBilling LeadPractice Manager

Why payers issue CO-24

The patient is assigned to a capitated group and the service falls under the cap
The patient's capitation assignment on file is wrong or outdated
A carve-out service that should be paid FFS was treated as capitated
The claim went to the wrong entity within a delegated arrangement

Is it recoverable? Recoverable when the patient wasn't truly capitated to you, or the service is a fee-for-service carve-out the cap doesn't cover — verify the assignment before writing it off.

Common questions

What does CO-24 mean?

How do I appeal or fix a CO-24 denial?

Recoverable when the patient wasn't truly capitated to you, or the service is a fee-for-service carve-out the cap doesn't cover — verify the assignment before writing it off. Common causes: the patient is assigned to a capitated group and the service falls under the cap; the patient's capitation assignment on file is wrong or outdated; a carve-out service that should be paid FFS was treated as capitated; the claim went to the wrong entity within a delegated arrangement.

Is a CO-24 denial worth appealing?

Recoverable when the patient wasn't truly capitated to you, or the service is a fee-for-service carve-out the cap doesn't cover — verify the assignment before writing it off. You only pay on what's actually recovered, so there's no cost to working the ones that are winnable.

Other denial codes

CO-197 · Precertification / Authorization Absent →CO-50 · Not Medically Necessary →CO-16 · Missing or Invalid Information →CO-45 · Charge Exceeds Fee Schedule →CO-97 · Bundled into Another Service →CO-29 · Timely Filing Expired →CO-96 · Non-Covered Charge →OA-18 · Duplicate Claim →OA-22 · Coordination of Benefits →CO-11 · Diagnosis Inconsistent with Procedure →CO-151 · Too Many Services (Frequency/MUE) →CO-B7 · Provider Not Eligible →CO-27 · Coverage Terminated →CO-204 · Not Covered Under Current Plan →CO-109 · Not Covered by This Payer →CO-119 · Benefit Maximum Reached →CO-4 · Modifier Inconsistent or Missing →CO-15 · Authorization Number Missing or Invalid →OA-23 · Prior Payer Adjudication Impact →CO-26 · Expenses Incurred Prior to Coverage →CO-54 · Assistant Surgeon Not Covered →CO-55 · Experimental / Investigational →CO-58 · Inappropriate Place of Service →CO-59 · Multiple/Concurrent Procedure Reduction →CO-107 · Related/Qualifying Claim Not Identified →CO-167 · Diagnosis Not Covered →CO-170 · Denied for This Provider Type →CO-181 · Procedure Code Invalid on Date of Service →CO-182 · Procedure Modifier Invalid on Date of Service →CO-183 · Referring Provider Not Eligible to Refer →CO-185 · Rendering Provider Not Eligible →CO-198 · Precertification / Authorization Exceeded →CO-226 · Requested Provider Information Not Provided →CO-231 · Mutually Exclusive Procedures →CO-234 · Procedure Not Paid Separately →CO-236 · Procedure/Modifier Combination Not Compatible →CO-242 · Out-of-Network / Non-Network Provider →CO-252 · Documentation Required to Adjudicate →CO-253 · Sequestration Reduction →CO-256 · Not Payable Per Managed-Care Contract →CO-288 · Referral Absent →CO-B15 · Qualifying Service Not Received →CO-B16 · New Patient Qualifications Not Met →CO-A1 · Claim/Service Denied (Remark Required) →

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