CO-96: Non-covered charges

What it means

CO-96 means the payer considers the charge non-covered. It is usually accompanied by a RARC that explains why the service is not covered, such as a benefit exclusion or a policy limitation. As a CO code the amount is a provider write-off unless the remark shifts it.

Mechanically this fires when the service falls outside the plan's covered benefits or a specific coverage rule. The distinction from PR-96 matters, because CO-96 lands on the provider while PR-96 makes the same non-covered charge the patient's responsibility, and the remark codes determine which applies.

Why it happens in behavioral health

In behavioral health CO-96 shows up on services a plan excludes or limits, such as certain experiential therapies, some assessment or ancillary codes bundled into a program rate, or a level of care the plan does not cover. Carve-out plans often exclude services that the medical plan would have paid.

SUD programs also see CO-96 when a bundled per diem is expected but individual component codes are billed separately, so the components read as non-covered. Read the accompanying RARC to confirm whether the exclusion is correct and whether the balance is truly a provider write-off.

How to fix it

• Read the accompanying RARC to learn the specific reason the charge is non-covered.
• Confirm the service is genuinely excluded versus a billing format issue like unbundling.
• If billing format caused it, correct the coding and resubmit under the covered structure.
• If the exclusion is real, verify whether it should be CO or PR before writing off or billing the patient.

How to prevent it

• Verify covered benefits and exclusions at intake for the specific plan and level of care.
• Bill bundled program services under the correct per diem or program code, not as separated components.
• Maintain a payer benefit grid for behavioral health service exclusions.

Related denial codes