CARC · CO group
CO-204
Service not covered under the patient's current benefit plan
Contractual obligation; provider write-off unless appealed
- What it means
- The plan does not include this service at all.
- Likely cause
- Couples or family therapy, coaching-style services, or testing on a plan without those benefits.
- How to fix it
- Verify benefits by CPT before the first session and collect a signed self-pay agreement where coverage does not exist.
- Revenue impact
- Patient responsibility if disclosed in advance; a write-off if not.
- non-covered
- benefits
- self-pay
Related codes
Early access
Seeing a lot of these?
Repeated CO-204 adjustments usually point to a step before submission. First Pass Paid is building pre-submission checks and a denial worklist to catch these earlier.
Join the early access list