CO 96 Denial Code in Medical Billing (2023)

Understanding the co 96 Denial Code can be complicated and overwhelming. In this article, we’ll break down everything you need to know about it, from what the CO 96 denial code means to how to ensure your medical claims are properly processed. We’ll also provide helpful topics on avoiding common mistakes that can lead to a denied claim. This comprehensive guide gives you all the information you need to navigate the insurance process confidently!

What is the CO 96 denial code?

CO 96 is a denial code used by insurance companies to indicate that a service or procedure has been denied because it is non covered charges. This code is typically used for claims that are submitted for services or procedures that are not considered medically necessary or that are not covered by the patient’s policy. It can be caused by an incorrect or missing information on the claim form, or if the service or procedure is not covered by the patient’s insurance plan.

Remark Codes in EOBReasonAction
N180 / N56It indicates wrong Dx code was used on the claim for the CPT code Billed. 1. Check LCD to confirm that the procedure code billed is covered and also check whether any modifier is missing.

2.Check with coder and resubmit the claim with correct DX code which is listed under LCD.
N115It indicates that the claim was denied based on the LCD submitted
M114The Beneficiary may be in a competitive bidding area you are not contracted with

CO 96 denial code meaning?

The co 96 denial code is a very common denial code used by insurance companies when denying claims. This code indicates that the claim was denied because the patient’s insurance plan did not cover the service. There are a few different reasons why an insurance plan may not cover a service, but the most common reason is that the service is not considered medically necessary.

  • Diagnosis (Dx) or procedure (CPT) performed or billed are not covered based on the LCD.
  • Services rendered not covered due to patient current benefit plan.
  • It may be due to provider contract with insurance company.

If you receive a co 96 denial code on your claim, it is important to understand why you denied the service and what you can do to appeal the decision. If you feel wrongly denied the service, you can contact your insurance company and ask them to review their decision. You may also want to contact your doctor or another medical provider to see if they have any suggestions on how to appeal the denial.

How to handle the co 96 denial code?

If your medical claim is denied with CO 96, it cannot be easy to understand why. The co 96 denial code indicates that the service or procedure you received is considered experimental or investigational. You’ll need to prove that the procedure is medically necessary to approve your claim.

It can be a difficult task, as many insurance companies are unwilling to cover procedures that they deem as experimental. However, it’s important to remember that you have the right to appeal a denial. If you believe the procedure, you received is medically necessary, you should gather any supporting documentation and file an appeal with your insurance company.

It’s also worth noting that some insurers will require pre-authorization for certain procedures. If you need clarification on whether or not your insurer requires pre-authorization, it’s best to contact them directly and ask. By doing so, you can avoid the hassle of having a claim denied down the road.


Knowing the information surrounding the co 96 denial code can be incredibly helpful for medical billing professionals. It is important to understand what causes a co 96 denial code , how to prevent them from occurring in the first place, and how to handle them when they occur properly. Knowing these details will help you get paid faster and improve your overall efficiency with filing claims. By using these tips and techniques outlined in this guide, you should now understand the basics behind the co 96 denial code to navigate potential payment issues better. It can make all the difference between getting paid for your services promptly or having to fight for reimbursement. In this blog post, we will go in-depth and discuss everything you need to know about the CO 96 Denial Code, from what it is to how to avoid and remediate denials.

FAQ- Frequently Asked Questions

Q1. How to fix CO 96 denied code? 

Ans. If you’re looking to fix a co 96 denial code, you can do a few things. First, check to see if it filed t correctly and if it included all the required information. If it were, you’d need to contact the payer to find out why the claim was denied. They should be able to provide you with more information about what’s needed to get the claim approved.
If you’re still having trouble, consider contacting a medical billing specialist. They’ll be able to help you figure out what’s needed to get your claim approved and get you the reimbursement you deserve.

Q2. Can I appeal again for a rejected claim with co 96? 

Ans. You could appeal the decision if your claim were denied with CO 96. However, it is important to understand why your claim of co 96 denial code was denied before you decide to appeal. If you do not have new evidence or information to submit, it is unlikely that your appeal will be successful.
co 96 denial code are generally issued when a claimant fails to provide enough information to support their claim. For example, the appeals board may deny your claim if you failed to submit medical records or documentation of your work history. Consider appealing the decision if you believe that you have new evidence or information supporting your claim.

Q3. What is necessary for approval of the Co 96 Denial Code 

Ans. Before you file an appeal, if you have gone through co 96 denial code ensure you have all the necessary documentation and evidence ready. It includes any medical records or documentation of your work history that you still need to submit. Once you have gathered the necessary documentation, you can file an appeal directly by contacting the appeals board.