CO-142 denial code
Monthly Medicaid patient liability amount
How to fix it
Bill the patient for the applied liability amount where state rules permit.
How to prevent it
Check patient liability at each visit for Medicaid populations; it is recalculated monthly.
In practice
A Medicaid patient in a long-term care setting has a monthly liability amount calculated from their income. The claim returns CO-142 with that amount applied, and the payer pays the balance.
This is not a denial. Patient liability is the share the state has determined the member contributes toward their care each month, and applying it is the program working as designed.
Whether the amount can be collected, and how, is governed by state rules rather than by the usual patient billing conventions. Confirm the state's requirements before sending a statement, because they differ substantially and some restrict collection sharply.
What sits behind it
The amount is recalculated monthly against income and circumstances, which means it changes and cannot be treated as a fixed figure. A practice assuming last month's amount will invoice the wrong number and create a reconciliation problem in both directions.
It also interacts with spend down, which is the related mechanism appearing under CO-30 and CO-178. Spend down is a threshold that has to be reached before coverage applies; patient liability is a share applied to services once coverage is active. The two are frequently conflated.
Where multiple providers serve the same patient in a month, the liability is allocated among them under state rules rather than charged in full by whoever bills first. Understanding the allocation is what prevents a patient being asked for the same contribution twice.
Related codes
Terms used here — Patient Responsibility · Eligibility Verification · Coordination of Benefits
How we handle it — Patient Collections · Eligibility Verification · Patient Support
Primary sources
The rules behind CO-142, at the bodies that publish them.
- Advance Beneficiary Notice of Noncoverage (ABN) (opens in a new tab)
Centers for Medicare & Medicaid Services — The form and the rules for issuing it. Whether a non-covered service can be billed to the patient usually turns on whether a valid ABN was obtained beforehand.
- No Surprises Act guidance (opens in a new tab)
Centers for Medicare & Medicaid Services — Balance billing restrictions, good faith estimates and the independent dispute resolution process — all of which change what a practice may bill a patient.
- Claim Adjustment Reason Codes (CARC) (opens in a new tab)
X12 — The authoritative, maintained CARC list. Our denial code lookup explains these in plain English; X12 is where the canonical definitions live.
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-142
Usually yes, but under state rules that vary considerably and sometimes restrict how and when. Confirm the applicable state requirements before sending a statement, because Medicaid billing restrictions are enforced and differ from ordinary patient billing conventions.
Spend down is a threshold of incurred expense that must be reached before coverage applies at all. Patient liability is a monthly contribution applied to services once coverage is active. The two are frequently confused because both reduce what the program pays.
Yes, it is recalculated against income and circumstances, so last month's figure is not a reliable guide. Where several providers serve the patient in one month, the amount is also allocated among them under state rules rather than charged in full by the first to bill.
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