What does denial code CO-96 mean?

CO-96 means: The service or item billed is not covered under the patient's insurance plan. The payer will not reimburse for this charge because it falls outside the scope of benefits.. This denial is received when the service billed is statutorily excluded from coverage under the Medicare program. Payment cannot be made for the service under Part A or Part B.

How do I resolve a CO-96 denial?

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

Can I appeal a CO-96 denial?

Yes. Most CO-96 denials can be appealed within 60-180 days depending on payer. Appeals may succeed if documentation proves the service should be covered under the plan or if incorrect coding led to the non-coverage determination. Use our free tool to generate an appeal letter.

CARC Code

96

🔴 Hard Denial

Non-Covered Charges

The service or item billed is not covered under the patient's insurance plan. The payer will not reimburse for this charge because it falls outside the scope of benefits.

contractual

Resolution: 38%Medium difficulty20-60 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-96 — stats, related codes, appeal template

38%

Recovery Rate

20-60 days

Avg. Resolution

Medium

Difficulty

Common

Frequency

Payer-Specific Notes

How major payers handle CARC 96 by specialty.

Medicare

CARC 96 often indicates a service not covered under Medicare Part B; review LCD for covered indications

Medicaid

State Medicaid has narrow covered service lists; verify through state provider manual

Common 835 Combinations

CARC 96 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-96The payer has identified charges that are non-covered under the contract, but COCO-96+N583This combination indicates the auto insurance carrier denied the claim because PRPR-96+M15The payer has determined that multiple separately billed services should have COCO-96+M114+M115+N211Medicare does not pay for this item or supply when provided by a non-contract COCO-96+M18Beneficiary was inpatient on date of service COCO-96+N115Medicare does not pay for this item or COCO-96+N180Non-covered charge(s). Item does not meet the criteria for the category under COCO-96+N425Non-covered charge(s). Medicare does not pay for this

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 96 denials.

We are appealing the non-covered charge denial (CARC 96) for claim [CLAIM_NUMBER]. Our review of the patient's benefit documents indicates this service should be covered under [BENEFIT_SECTION]. We are enclosing clinical documentation and the relevant plan benefit language to support reconsideration.

Generate a personalized appeal letter →

Need to resolve this denial?

Get a step-by-step resolution plan with payer-specific guidance and appeal letter generation.

Resolve this denial →

Was this helpful?

← Back to Code Library Automate denial follow-up →