CO-96: Non-Covered Charges
Non-covered charge(s). At least one remark code must be provided to explain why the charge is not covered.
Why Claims Get Denied with CO-96
Denial code CO-96 is triggered when non-covered charge(s). at least one remark code must be provided to explain why the charge is not covered. Understanding the root causes helps prevent future denials and strengthens your appeal when one occurs.
Service excluded from the patient's benefit plan
Cosmetic procedure not covered
Service considered experimental or investigational by the payer
Service not covered for the specific diagnosis billed
How to Appeal CO-96
Review the accompanying remark codes for specific reasons. If the service should be covered, gather benefit plan documentation and clinical evidence. If the payer classified the service incorrectly (e.g., calling a reconstructive procedure cosmetic), provide documentation establishing the medical necessity distinction.
Documentation Required for Appeal
A successful appeal of CO-96 requires thorough documentation. Gather these items before drafting your appeal letter:
Benefit plan documentation showing coverage
Clinical notes distinguishing medical necessity from elective/cosmetic
ABN or financial responsibility documentation
Payer policy references
How to Prevent CO-96 Denials
Verify coverage and benefits before rendering services. Obtain advance beneficiary notices (ABNs) for Medicare services that may not be covered. Check the patient's specific plan exclusions.
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