Denial Codes List

To view details about a specific denial code, simply search for and click on the code listed below.
If you're looking for denial codes by category, use the search bar to filter results. For example, entering keywords such as "Most Common Denials" will display codes like CO 04, CO 11, and CO 16, etc.. Available categories include:

• Common Denials
• Most Common Denials

Please note that not all denial codes are listed. The current list includes the most and least common codes typically encountered by billing teams on a daily or monthly basis.
If you notice a denial code missing that should be included, kindly reach out via the Contact or Feedback section — we will review and add it as appropriate.

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Codes	Reason / Description
04	The procedure code is inconsistent with the modifier used.	CO 04 PI 04 OA 04 PR 04 Most Common Denials
05	Procedure code/bill type is inconsistent with the place of service.	CO 05 PI 05 OA 05 PR 05 Common Denials
06	The procedure/revenue code is inconsistent with the patient’s age.	CO 06 PI 06 OA 06 PR 06 Common Denials
07	The procedure code is inconsistent with the patient's gender.	CO 07 PI 07 OA 07 PR 07 Common Denials
08	The procedure code is inconsistent with the provider type or specialty (taxonomy).	CO 08 PI 08 OA 08 PR 08 Common Denials
10	The diagnosis is inconsistent with the patient's gender.	CO 10 PI 10 OA 10 PR 10 Common Denials
11	The diagnosis is inconsistent with the procedure.	CO 11 PI 11 OA 11 PR 11 Most Common Denials
12	The diagnosis is inconsistent with the provider type.	CO 12 PI 12 OA 12 PR 12 Common Denials
13	The date of death precedes the date of service.	CO 13 PI 13 OA 13 PR 13 Common Denials
14	The patient's date of birth is after the date of service.	CO 14 PI 14 OA 14 PR 14 Common Denials
16	Claim/service lacks information or has submission/billing error(s) which is needed for adjudication.	CO 16 PI 16 OA 16 PR 16 Most Common Denials
18	An exact duplicate claim or service.	CO 18 PI 18 OA 18 PR 18 Most Common Denials
19	The insurance company denies payment because they believe the injury or illness is related to work and should be covered by Worker's Compensation.	CO 19 PI 19 OA 19 PR 19 Common Denials
22	This care may be covered by another payer per coordination of benefits.	CO 22 PI 22 OA 22 PR 22 Most Common Denials
23	The impact of prior payer(s) adjudication including payments and/or adjustments. / a prior payer's decision affects the payment or adjustments made.	CO 23 PI 23 OA 23 PR 23 Most Common Denials
24	Charges are covered under a capitation agreement/managed care plan.	CO 24 PI 24 OA 24 PR 24 Common Denials
26	Expenses incurred prior to coverage.	CO 26 PI 26 OA 26 PR 26 Most Common Denials
27	Expenses incurred after coverage terminated.	CO 27 PI 27 OA 27 PR 27 Most Common Denials
29	The time limit for filing has expired.	CO 29 PI 29 OA 29 PR 29 Most Common Denials
31	Patient cannot be identified as our insured.	CO 31 PI 31 OA 31 PR 31 Most Common Denials
32	Our records indicate that this dependent is not an eligible dependent as defined.	CO 32 PI 32 OA 32 PR 32 Common Denials
45	Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.	CO 45 PI 45 OA 45 PR 45 Most Common Denials
50	These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.	CO 50 PI 50 OA 50 PR 50 Most Common Denials
58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.	CO 58 PI 58 OA 58 PR 58 Common Denials
96	Non-covered charge(s).	CO 96 PI 96 OA 96 PR 96 Most Common Denials
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.	CO 97 PI 97 OA 97 PR 97 Most Common Denials
109	Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.	CO 109 PI 109 OA 109 PR 109 Most Common Denials
119	The maximum benefit for this time period or occurrence has been reached.	CO 119 PI 119 OA 119 PR 119 Common Denials
129	Payment denied - Prior processing information appears incorrect.	CO 129 PI 129 OA 129 PR 129 Common Denials
132	Prearranged demonstration project adjustment.	CO 132 PI 132 OA 132 PR 132 Common Denials
134	Technical fees removed from charges.	CO 134 PI 134 OA 134 PR 134 Common Denials
136	Failure to follow prior payer's coverage rules.	CO 136 PI 136 OA 136 PR 136 Common Denials
137	Regulatory surcharges, assessments, allowances, or health-related taxes that were not approved for reimbursement.	CO 137 PI 137 OA 137 PR 137 Common Denials
144	An incentive adjustment, like a preferred product or service, that has been denied for reimbursement.	CO 144 PI 144 OA 144 PR 144 Common Denials
147	Provider contracted/negotiated rate expired or not on file.	CO 147 PI 147 OA 147 PR 147 Common Denials
150	The payer believes / deems the information provided does not justify the level of service.	CO 150 PI 150 OA 150 PR 150 Common Denials
151	Payment adjusted because the payer deems the information submitted does not support this level of service.	CO 151 PI 151 OA 151 PR 151 Most Common Denials
197	The precertification/authorization/notification/pre-treatment is missing.	CO 197 PI 197 OA 197 PR 197 Most Common Denials
198	The precertification, notification, authorization, or pre-treatment requirement has been exceeded.	CO 198 PI 198 OA 198 PR 198 Common Denials
204	This service/equipment/drug is not covered under the patient’s current benefit plan.	CO 204 PI 204 OA 204 PR 204 Most Common Denials
207	Invalid format of the National Provider Identifier (NPI).	CO 207 PI 207 OA 207 PR 207 Common Denials
208	National Provider Identifier (NPI) does not match. / NPI not on file.	CO 208 PI 208 OA 208 PR 208 Most Common Denials
210	The payment was adjusted because pre-certification/authorization was not received on time.	CO 210 PI 210 OA 210 PR 210 Common Denials
236	A procedure or combination of procedures is not compatible with another procedure or combination provided on the same day, as per coding guidelines or workers compensation regulations/fee schedules.	CO 236 PI 236 OA 236 PR 236 Common Denials
242	Services not provided by network/primary care providers.	CO 242 PI 242 OA 242 PR 242 Most Common Denials
250	The attachment/other documentation that was received was the incorrect attachment/document. The expected attachment/document is still missing.	CO 250 PI 250 OA 250 PR 250 Common Denials
251	The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim.	CO 251 PI 251 OA 251 PR 251 Common Denials
252	An attachment/other documentation is required to adjudicate this claim/service.	CO 252 PI 252 OA 252 PR 252 Most Common Denials
275	The prior payer does not cover the patient's responsibility, like deductibles or co-payments.	CO 275 PI 275 OA 275 PR 275 Common Denials
276	The services rejected by the previous payer are not covered by the current payer.	CO 276 PI 276 OA 276 PR 276 Common Denials
288	Referral absent / a referral is missing or not provided, resulting in a claim denial.	CO 288 PI 288 OA 288 PR 288 Most Common Denials
296	When the precertification/authorization/notification/pre-treatment number is valid but doesn't apply to the provider.	CO 296 PI 296 OA 296 PR 296 Common Denials
B07	This provider was not certified/eligible to be paid for this procedure/service on this date of service.	CO B07 PI B07 OA B07 PR B07 Most Common Denials
B09	Patient is enrolled in a Hospice.	CO B09 PI B09 OA B09 PR B09 Most Common Denials
B11	The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.	CO B11 PI B11 OA B11 PR B11 Common Denials
B13	Previously paid. Payment for this claim/service may have been provided in a previous payment.	CO B13 PI B13 OA B13 PR B13 Most Common Denials