CO-276 denial code
Services denied by the prior payer are not covered by this payer
How to fix it
Resolve the primary denial first; the secondary will not pay while it stands.
How to prevent it
Always work the primary denial before touching the secondary claim.
In practice
A primary payer denies a service as non-covered. The practice bills the secondary, which returns CO-276 because it does not cover services the primary denied.
The secondary's benefit is defined by reference to the primary's. Where the primary excluded the service, the secondary excludes it too, and no appeal to the secondary changes that.
Resolve the primary denial or accept the outcome. Where the primary's denial was correct, the balance moves to the patient or to write-off depending on the terms.
What sits behind it
This is the strictest of the coordination codes. CO-136 says the primary's rules were not followed, CO-196 says the secondary adopted the primary's determination, and CO-276 says the secondary simply does not cover what the primary declined.
The narrow exception is a secondary with genuinely broader benefits, which does exist but has to be verified rather than hoped for. Reading the secondary's coverage terms for the specific service is the only way to know before billing.
Because the outcome depends entirely on the primary, effort spent appealing the secondary is effort spent in the wrong place. The primary determination is the one that decides both claims.
Related codes
Terms used here — Coordination of Benefits · Denial · Appeal
How we handle it — Denial Management · AR Management · Claims Management
Primary sources
The rules behind CO-276, 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-276
Rarely. The secondary's benefit is defined by reference to the primary's determination, so the appeal has to succeed at the primary to change anything. Effort spent on the secondary claim is effort spent on the wrong payer.
It happens, but it has to be verified rather than assumed. Reading the secondary's coverage terms for the specific service before billing tells you whether the attempt is worth making at all.
CO-136 says the primary's rules were not followed, CO-196 says the secondary adopted the primary's determination, and CO-276 says the secondary does not cover what the primary declined. All three point back to resolving the primary first.
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