Denial codes with brief description
PR 1- Deductible amount
PR 2- Co-insurance amount
PR 3- Co-pay amount
CO 4- Modifier is missing/procedure code inconsistent with modifier
CO 5- Procedure code inconsistent with POS
CO 6- Procedure code inconsistent with patient’s age
CO 7- Procedure code inconsistent with patient’s gender
CO 8- Procedure code inconsistent with provider type or specialty
CO 9- Diagnosis code inconsistent with patient’s age
CO 10- Diagnosis code inconsistent with patient’s gender
CO 11- Diagnosis code inconsistent with procedure code
CO 15- Payment adjusted because of invalid or missing authorization number
CO 19- Claim denied for work related injury
CO 22- This care may be covered by another payer as per COB
CO 23- Payment adjusted because charges paid by another payer
CO 24- Charges are covered under capitation
CO 26- Expenses incurred prior to coverage termination
CO 27- Expenses incurred after coverage terminated
CO 31- Patient cannot be identified
CO 40- Charges do not meet qualification for emergency
CO 50- Not medical necessity
CO 119- Benefit maximum for this time period has been reached
Some commonly used denial codes
CO 96- For non-covered services
CO 97- Bundled or inclusive or mutually exclusive
CO 197- No authorization
CO 45- For contractual adjustment/write off( This code is not a denial but is used often)
CO 109- Covered by another payer
CO 29- Untimely filing
CO 18- Duplicate claim
CO 16- Lack of information
Denial group codes
(You will frequently see them in your EOB/ERA)
PR- Patient Responsibility
CO- Contractual Obligation
OA- Other Adjustment
PI- Payer Initiated Reductions
CR- Corrections and Reversal
