CO-202 denial code
Non-covered personal comfort or convenience services
How to fix it
Bill the patient where an advance notice was properly obtained.
How to prevent it
Identify non-covered comfort items in advance and obtain written patient acknowledgement.
The CO prefix marks this a contractual obligation. The balance is absorbed by the provider under the payer agreement and cannot be transferred to the patient.
In practice
A facility bills a private room upgrade requested by the patient for personal preference rather than clinical isolation. The plan returns CO-202 as a comfort or convenience item.
Plans cover medically necessary care and exclude items that make a stay more comfortable without changing its clinical course. The distinction is about necessity, not about whether the item has value.
Whether the patient can be billed depends entirely on what they agreed to beforehand. A written acknowledgement obtained before the item was provided makes it collectable; without one, most contracts prevent billing and the charge is absorbed.
What sits behind it
The category is broader than the obvious examples. Private rooms without clinical indication, television and telephone charges, guest meals, personal hygiene items and certain equipment upgrades all fall inside it, and patients rarely appreciate which choices carry cost.
Where an item is clinically indicated, the exclusion does not apply and the denial is worth challenging. A private room required for isolation is a medical necessity, not a comfort, and documentation of the clinical reason converts the appeal from argument to fact.
The workflow answer is a written acknowledgement at the point of the choice. A patient who selects an upgrade should understand what it costs and agree in writing then, which serves both the practice's collectability and the patient's ability to decide.
Related codes
Terms used here — Patient Responsibility · Medical Necessity · Denial
How we handle it — Patient Collections · Patient Support · Denial Management
Primary sources
The rules behind CO-202, at the bodies that publish them.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
- Medicare Benefit Policy Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — What Medicare covers and under what conditions, as distinct from how a claim is processed. The starting point for any coverage or medical necessity question.
- 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.
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-202
Private rooms without clinical indication, television and telephone charges, guest meals, personal hygiene supplies and certain equipment upgrades. The common thread is that the item improves the experience without changing the clinical course of care.
Yes, where it is clinically indicated — isolation requirements being the clearest case. Documentation of the clinical reason converts this from an appeal about preference to a straightforward medical necessity question, and those appeals generally succeed.
Where they were told the item was not covered and agreed in writing before receiving it. Obtaining that acknowledgement at the point of choice serves both collectability and the patient's ability to make an informed decision about something optional.
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