How do I resolve a CO-96+M18 denial?

If wrong date of service was billed, suppliers may do a self service reopening in the Noridian Medicare Portal. When provided within 2 days prior to anticipated discharge to home, the discharge date must be billed If beneficiary was not inpatient on date items were provided, contact the facility to update their billing. You can find the NPI of the facility through the claim status page under expanded denial details of the NMP for that specific claim. Once that billing update is verified through Self Service, supplier can either do a self service reopening or rebill the claim for the correct date of service.

Can I appeal a CO-96+M18 denial?

CO-96+M18 denials are generally not appealable. Beneficiary was inpatient on date of service billed

835 Denial Combination

CO-96+M18

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Beneficiary was inpatient on date of service billed

N/A

Appeal Success

7-14 days

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-96+M18 combination — not generic advice.

1
If wrong date of service was billed, suppliers may do a self service reopening in the Noridian Medicare Portal. When provided within 2 days prior to anticipated discharge to home, the discharge date must be billed
2
If beneficiary was not inpatient on date items were provided, contact the facility to update their billing. You can find the NPI of the facility through the claim status page under expanded denial details of the NMP for that specific claim. Once that billing update is verified through Self Service, supplier can either do a self service reopening or rebill the claim for the correct date of service.

Specialty Context

How CO-96+M18 typically presents across different practice types.

Dental

Medical

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

CARC 96 RARC M18

Medicare Contractor Guidance for CARC 96

FCSO + Noridian

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 to Prevent CARC 96 Denials

✓
Review the service billed to ensure the correct code was submitted.
✓
If the claim is being submitted for statutorily excluded services, you can append a GY modifier to the line item. The GY modifier indicates that the item or service is statutorily excluded or does not meet the definition of a Medicare benefit.

Items & Services Not Covered Under MedicareStatutory exclusion from Medicare benefits - §1862(a)Noridian Medicare PortalCompetitive Bid HCPCS Lookup ToolCBA Zip Code Lookup ToolNMPModifier Lookup Tool

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