Coverage

Denial code CO-96: Non-covered charge(s)

The service is not a benefit under this plan — the remark codes explain which exclusion applies.

Reason code

CARC 96

Typical group code

What CO-96 actually means

CO-96 is a broad benefit exclusion, and like CO-16 it is a container: the accompanying remark codes carry the specific reason. Some CO-96 denials are true plan exclusions where the balance is the patient’s; others turn out to be statutory exclusions, non-covered settings, or missing information dressed up as an exclusion. Read the remarks before deciding whether this is a write-off, a patient bill, or an appeal.

Why this denial happens

The service is genuinely excluded from the plan’s benefits.
The service is statutorily excluded for that payer type.
A required advance notice of non-coverage was not on file.
The service is not covered in the setting where it was performed.

How to resolve a CO-96 denial

Read the RARC remark codes to identify the specific exclusion.
Confirm the exclusion against the plan documents rather than assuming.
If a valid advance notice was signed, transfer the balance to the patient.
Appeal where the service was miscategorised or where the exclusion does not apply to the billed indication.

How to prevent it

Verify benefit coverage — not just eligibility — for services you know are frequently excluded.
Collect signed advance notices of non-coverage before rendering excluded services.

Frequently asked

What does denial code CO-96 mean?

The service is not a benefit under this plan — the remark codes explain which exclusion applies. The X12 description reads: "Non-covered charge(s)."

How do I fix a CO-96 denial?

Read the RARC remark codes to identify the specific exclusion. Confirm the exclusion against the plan documents rather than assuming. If a valid advance notice was signed, transfer the balance to the patient. Appeal where the service was miscategorised or where the exclusion does not apply to the billed indication.

Can CO-96 be billed to the patient?

This code normally moves the balance to patient responsibility, subject to your payer agreement and to any advance notice of non-coverage requirements that apply.

Related denial codes

CO-49 · Routine or preventive service not covered PR-204 · Not covered under the patient’s current benefit plan CO-55 · Experimental or investigational CO-109 · Not covered by this payer — send to the correct payer

See how much CO-96 is costing you

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General revenue-cycle guidance, not legal, coding, or payer-specific advice. Claim adjustment reason codes are maintained by X12 and are revised periodically; payer policy and your provider agreement govern in any specific case. Always read the remark codes transmitted with the denial — they frequently carry the detail this code does not.