CO-96 Denial Code: Non-Covered Charge
CARC 96 is a general non-coverage code and must be paired with a RARC for detail. It can mean the patient's plan excludes the service, the service is excluded by statute, or the payer does not cover the service in that setting or by that provider type.
Also appears as PR-96. The group code changes who is responsible, not the reason.
CO-96 means the payer considers the charge not covered. The RARC that comes with it explains why, such as a plan exclusion or a statutory exclusion. Verify the patient's benefits for that service. If it is truly excluded, patient billing depends on your contract and any waiver the patient signed.
Common causes of CO-96.
- Service excluded under the patient's benefit plan
- Service statutorily excluded (for Medicare, for example, routine services with no benefit category)
- Service not covered in the place of service billed
- Benefit limits reached for the year
How to work a CO-96 denial.
The order matters: confirm the facts before deciding between a corrected claim, a reconsideration, or an adjustment.
- 1Read the RARC to understand the specific reason for non-coverage.
- 2Verify the patient's benefits for that exact service with the payer.
- 3If the payer misapplied an exclusion, request reconsideration with benefit information.
- 4If the service is excluded, check whether a patient waiver or ABN was signed and whether your contract permits patient billing.
How to keep CO-96 from coming back.
- Verify service-level benefits, not just active coverage, before non-routine services
- Use financial waivers or ABNs where appropriate and permitted
Fixing this at the source usually sits with eligibility verification →
Questions about CO-96.
Denials that often travel with this one.
CO-204: Service Not Covered Under Current Benefit Plan
CO-204 (often PR-204) means the service is not covered under the patient's current benefit plan. How to verify benefits and handle patient responsibility.
Read about CO-204 →CO-50: Not Deemed Medically Necessary
CO-50 means the payer decided the service was not medically necessary. How to review policy and documentation, build an appeal, and handle ABNs for Medicare.
Read about CO-50 →CO-170: Not Payable When Billed by This Provider Type
CO-170 means the payer will not pay this service when billed by this provider type. How enrollment, taxonomy, and credentialing gaps cause it and how to fix it.
Read about CO-170 →Add a Dedicated Denial Specialist
RCM Staff places trained denial management specialists inside your EHR and clearinghouse to work the queue, correct and appeal claims, and track root causes by payer.
Kevin Jamito has 18+ years of U.S. healthcare revenue cycle management experience across billing, coding, practice management, and offshore RCM operations. He founded RCM Staff to give U.S. healthcare teams dedicated Philippines-based specialists who work inside their existing systems.