CO-273Contractual ObligationMedical Necessity
CO-273 Denial Code: Coverage/program guidelines exceeded
The service exceeded plan guidelines — beyond allowed frequency, quantity, or scope.
Why CO-273 happens
- ●Visit/unit limits exceeded (therapy caps, screening frequencies)
How to fix a CO-273 denial
- 1
Verify accumulators; appeal with medical necessity for services beyond limits where the plan allows exceptions
How to prevent it
Track benefit-limit utilization for cap-prone services during the year.
Drowning in CO-273 denials?
OakClaim works every denial within 48 hours and builds prevention rules so they stop recurring.