CO-273 denial code
Coverage or program guidelines were exceeded
How to fix it
Confirm the applicable limit and appeal with medical necessity where exceeding it was justified.
How to prevent it
Track frequency limits for screening and preventive services; they are the most commonly exceeded.
In practice
A patient receives a preventive service twice within a period the plan covers it once. The second claim returns CO-273 for exceeding the coverage guideline.
Frequency limits are set by coverage policy and applied automatically. The service was covered; it was simply covered less often than it was delivered.
Where the repeat was clinically justified, the appeal has to establish that with documentation of the reason. Where it was routine, the limit stands and the patient becomes responsible if properly noticed beforehand.
What sits behind it
Preventive and screening services carry the tightest limits and generate most of these denials — screening examinations, laboratory panels, vaccinations, and wellness visits each have defined intervals that vary by payer and by patient risk category.
Risk-based intervals are frequently missed. Many policies allow more frequent screening for patients meeting defined risk criteria, and coding the risk factor rather than the routine screening indication can make the second service payable without any appeal.
Where the limit is genuinely reached, the useful step is prospective. Tracking interval-limited services against the patient's history lets scheduling place the next one on the payable side of the line rather than discovering the problem afterwards.
Related codes
Terms used here — Medical Necessity · Eligibility Verification · Patient Responsibility
How we handle it — Eligibility Verification · Denial Management · Practice Analytics
Primary sources
The rules behind CO-273, 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-273
Yes, where clinical circumstances justify it and the documentation shows why. Many policies also allow more frequent screening for patients meeting defined risk criteria, in which case coding the risk factor rather than a routine indication makes the service payable directly.
Preventive and screening services — screening examinations, laboratory panels, vaccinations and wellness visits. Intervals vary by payer and by the patient's risk category, so a single remembered rule is rarely reliable across a payer mix.
By tracking interval-limited services against the patient's history so scheduling places the next one on the payable side of the boundary. Discovering the limit at denial means the service has already been delivered and the cost already incurred.
Find out what your denials are costing you
A free billing audit reviews your denial rate, AR aging and clean claim rate against industry benchmarks. Takes about two minutes to request. No sales pitch.
No setup fees · You pay when we collect · Pricing from 3% of net collections