CO 154 denial code
Claim adjustment reason code 154. Often reported as CO 154.
Records do not support day's supply
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What 154 means
The payer decided the documentation does not justify the number of days of supply that was billed.
This applies mainly to drugs and supplies dispensed for a period of time. The payer does not accept the number of days the supply was billed for, often because it exceeds limits or does not match the quantity and directions.
Check the quantity, directions and days billed together. They must agree with each other and with the order.
Group codes seen with 154
On a remittance, 154 comes after a group code. These are the ones it is most often reported with:
- CO 154 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.
Common causes
- The days supply did not match the quantity and the directions on the order.
- The supply exceeded the payer's limit for a single fill or delivery.
- A refill was billed before the previous supply should have run out.
What to do next
- Recalculate the days supply from the quantity and the directions on the order.
- Check the payer's limits on days supply and refill timing.
- Correct the claim and resubmit, or appeal with the order if the supply was justified.
Related codes
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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