What does denial code CO-49 mean?

CO-49 means: The service was denied because it is a routine or preventive exam, or a screening/diagnostic procedure performed during a routine preventive visit, which is not covered under the patient's plan. The payer considers this a non-covered benefit.. The denial was received because the service is a routine or preventive exam, or diagnostic / screening procedure done in conjunction with a routine or preventative exam. Diagnostic / screening procedures and evaluation and management (E/M) services for routine or screening purposes, such as an annual physical, are not covered by Medicare.

How do I resolve a CO-49 denial?

If an error was made, make the necessary correction, and resubmit your claim. If a payable diagnosis is indicated in the patient's medical record, be sure to include the diagnosis, and resubmit the claim. See full Medicare contractor resolution steps at tryarceum.com.

Can I appeal a CO-49 denial?

CO-49 denials are generally not appealable. This is a contractual benefit limitation indicating the service category is excluded from coverage, not a processing error or medical necessity issue.

CARC Code

49

🔴 Hard Denial

Routine/Preventive Exam Not Covered

The service was denied because it is a routine or preventive exam, or a screening/diagnostic procedure performed during a routine preventive visit, which is not covered under the patient's plan. The payer considers this a non-covered benefit.

contractual

Resolution: 55%Medium difficulty14-30 days avg

How to resolve this denial

Which payer denied this claim?

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

Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.

▶More about CO-49 — stats, related codes, appeal template

55%

Recovery Rate

14-30 days

Avg. Resolution

Medium

Difficulty

Occasional

Frequency

Payer-Specific Notes

How major payers handle CARC 49 by specialty.

Medicare

AWV (Annual Wellness Visit) and separate E/M on same day: use modifier 25; document separately

UnitedHealthcare

Modifier 25 required when billing problem-focused E/M on same day as preventive visit

Common 835 Combinations

CARC 49 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-49The payer has determined that the service billed is a routine or preventive

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 49 denials.

We are appealing denial of claim [CLAIM_NUMBER] under CARC 49. The service billed under [CPT_CODE] was not a routine screening but a separately identifiable problem-focused service for [DIAGNOSIS]. We have appended modifier [MODIFIER] and updated the diagnosis code to reflect the medically necessary nature of this service.

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