What does denial code CO-24 mean?

CO-24 means: The service is already paid for through a capitation arrangement where the provider receives a fixed monthly payment per patient, rather than being paid for individual services. No additional payment will be made for this claim.. This reason code is received when a claim is submitted to Medicare, and the beneficiary is enrolled in a Medicare Advantage plan or is covered under a capitation agreement. Charges are covered under a capitation agreement / managed care plan.

How do I resolve a CO-24 denial?

If the beneficiary's record with CMS is updated to reflect that he/she was not enrolled in an MA plan on the date(s) of service in question, resubmit the claim to First Coast. See full Medicare contractor resolution steps at tryarceum.com.

Can I appeal a CO-24 denial?

CO-24 denials are generally not appealable. This is a contractual adjustment based on a capitation agreement the provider has signed; the provider has already been compensated through the capitated payment model.

CARC Code

24

🔵 Informational

Covered Under Capitation Agreement

The service is already paid for through a capitation arrangement where the provider receives a fixed monthly payment per patient, rather than being paid for individual services. No additional payment will be made for this claim.

contractual

Resolution: 99%Easy difficulty1-3 days avg

How to resolve this denial

Which payer denied this claim?

▶✓ Pre-action checklist — verify before contacting the payer

Is this a capitated service? Check your contract for what's included in the cap rate.
Verify the patient is attributed to your practice under the capitation arrangement.

Still denied?

Formal Appeal

If the payer upheld the denial after reconsideration, you can submit a formal appeal.

Generate appeal letter →

▶More about CO-24 — stats, related codes, appeal template

99%

Recovery Rate

1-3 days

Avg. Resolution

Easy

Difficulty

Rare

Frequency

Payer-Specific Notes

How major payers handle CARC 24 by specialty.

UnitedHealthcare

Review UHC's online claim status tool for additional detail on this adjustment.

Appeal Letter Template

Generic appeal template for CARC 24 denials.

We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 24 indicating: "Charges are covered under a capitation agreement/managed care plan.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.

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