DENIAL CODE · CO-256

CO-256: Not Payable Per Managed-Care Contract

CO-256 means the payer says your managed-care contract doesn't cover this service as billed. Sometimes that's the true contract terms; sometimes it's a wrong fee-schedule or carve-out reading.

Official (X12/WPC): "Service not payable per managed care contract."

Why payers issue CO-256

  • The service falls outside the contract's covered terms
  • The claim priced against the wrong contract or fee schedule
  • A carve-out or delegated arrangement was misread
  • The contract terms on file are outdated

Is it recoverable? Worth checking the contract language and the loaded fee schedule — mis-mapped contracts and wrong carve-outs are recoverable; true contract exclusions are not.

Common questions

What does CO-256 mean?

CO-256 means the payer says your managed-care contract doesn't cover this service as billed. Sometimes that's the true contract terms; sometimes it's a wrong fee-schedule or carve-out reading. Service not payable per managed care contract.

How do I appeal or fix a CO-256 denial?

Worth checking the contract language and the loaded fee schedule — mis-mapped contracts and wrong carve-outs are recoverable; true contract exclusions are not. Common causes: the service falls outside the contract's covered terms; the claim priced against the wrong contract or fee schedule; a carve-out or delegated arrangement was misread; the contract terms on file are outdated.

Is a CO-256 denial worth appealing?

Worth checking the contract language and the loaded fee schedule — mis-mapped contracts and wrong carve-outs are recoverable; true contract exclusions are not. 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-24 · Charges Covered Under Capitation →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-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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