DENIAL CODE · CO-96

CO-96: Non-Covered Charge

CO-96 means the payer says the service isn't a covered benefit under the patient's plan. Some are truly non-covered; many are mis-categorized or mis-coded.

Official (X12/WPC): "Non-covered charge(s)."

Why payers issue CO-96

  • The service genuinely isn't a plan benefit
  • It was coded in a way that looked non-covered when a covered code applied
  • Benefits weren't verified before the visit
  • The plan covers it with conditions that weren't met or shown

Is it recoverable? The value is knowing which are winnable — appeal with correct coding or medical necessity, and write off only the truly excluded.

How to appeal a Non-Covered Service denial →

Common questions

What does CO-96 mean?

CO-96 means the payer says the service isn't a covered benefit under the patient's plan. Some are truly non-covered; many are mis-categorized or mis-coded. Non-covered charge(s).

How do I appeal or fix a CO-96 denial?

The value is knowing which are winnable — appeal with correct coding or medical necessity, and write off only the truly excluded. Common causes: the service genuinely isn't a plan benefit; it was coded in a way that looked non-covered when a covered code applied; benefits weren't verified before the visit; the plan covers it with conditions that weren't met or shown.

Is a CO-96 denial worth appealing?

The value is knowing which are winnable — appeal with correct coding or medical necessity, and write off only the truly excluded. 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 →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-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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