CommonContractual Obligation (CO)Eligibility & Coverage

CO-96: Non-covered charge(s)

The service is not covered under the patient's benefit plan. Unlike CO-50 (which is a medical necessity denial), CO-96 means the service is categorically excluded from the patient's insurance benefits regardless of medical necessity.

Common Causes

  • The service is explicitly excluded from the patient's plan benefits
  • Plan does not cover this category of service (e.g., cosmetic, fertility, weight loss)
  • Out-of-network provider and plan has no out-of-network benefits
  • Service requires a plan rider that the patient does not have
  • Benefit limit reached (e.g., annual maximum for a service type)

How to Resolve CO-96

  1. 1Verify the patient's plan benefits for this specific service category
  2. 2If the service should be covered, appeal with the benefit plan documentation
  3. 3If not covered, inform the patient and collect patient responsibility
  4. 4Check if the patient has secondary insurance that might cover the service
  5. 5Review if a different procedure code might be covered under the plan

How to Prevent CO-96 Denials

  • Verify benefits for the specific service before scheduling
  • Obtain benefit details beyond eligibility -- coverage does not mean the specific service is covered
  • Inform patients of non-covered services and collect consent/payment upfront
  • Maintain a reference of commonly excluded services by payer and plan type

Related Denial Codes

CO-50Very Common

Non-covered service (not deemed medically necessary)

CO-109Common

Claim not covered by this payer

CO-27Common

Expenses incurred after coverage terminated

Stop Denials Before They Happen

Greenlight verifies patient eligibility, benefits, and network status automatically before every visit -- catching coverage issues before they become denials.

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