CO-204Contractual ObligationEligibility
CO-204 Denial Code: Service not covered under current benefit plan
This service, equipment, or drug is not covered under the patient's current benefit plan.
Why CO-204 happens
- ●Plan-level exclusion for the service or drug
- ●Formulary exclusion for the billed NDC
How to fix a CO-204 denial
- 1
Confirm the exclusion in the benefit document
- 2
Check for covered alternatives or exception processes
- 3
Bill the patient if notice requirements were satisfied
How to prevent it
Verify service-specific benefits and formulary status pre-service.
Drowning in CO-204 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.