CO-287 denial code
Referral exceeded
How to fix it
Obtain an extended referral and request reprocessing where the plan permits.
How to prevent it
Track referral visit counts the way authorisation units are tracked.
In practice
A referral authorises six physical therapy visits. The course runs to nine, and claims for the last three return CO-287.
Referrals carry limits in the same way authorisations carry units, and the limit exhausts silently. Nothing announces the sixth visit; the seventh simply denies.
Request an extended referral from the primary care physician covering the additional visits, and ask the plan to reprocess. Many plans permit this where the extension is obtained promptly.
What sits behind it
Counting is the whole problem. Practices track authorisation units routinely and referral visits much less often, even though both are finite permissions that exhaust without warning.
Multi-provider situations make the count harder still. Where a referral covers a course delivered by several providers in a group, visits consumed by one reduce what remains for the others, and no one holds the running total unless someone chooses to.
The prevention is a report rather than a memory. Knowing which patients are approaching their referral limit next week lets the extension be requested before the visit rather than after the denial, which is the difference between a routine renewal and a lost encounter.
Related codes
Terms used here — Prior Authorization · Denial · Eligibility Verification
How we handle it — Prior Authorization · Denial Management · AR Management
Primary sources
The rules behind CO-287, at the bodies that publish them.
- CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) (opens in a new tab)
Centers for Medicare & Medicaid Services — The rule imposing prior authorization decision timelines and API requirements on impacted payers. It is the single largest scheduled change to authorization workflow this decade.
- 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 Claims Processing Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — The operative manual for how Medicare claims must be coded, submitted, adjusted and appealed. When a payer policy and a vendor's advice disagree, this settles it.
Looking for a different code? Search all 190 CARC and RARC codes
Questions about CO-287
Many plans allow it where an extended referral is obtained promptly and reprocessing is requested. The likelihood drops the longer the gap, so requesting the extension as soon as the denial appears matters more than the appeal argument.
Because practices track authorisation units routinely and referral visits much less often, even though both exhaust silently. Nothing announces the last covered visit, so the count only becomes visible when a claim denies.
Visits consumed by one provider reduce what remains for the others under the same referral, and no one holds the running total unless the practice deliberately maintains it. A shared report is the only reliable way to know where a course stands.
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