CO 193 denial code

Claim adjustment reason code 193. Often reported as CO 193 or PR 193.

Original decision upheld after review

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 Nov 11, 2026.

What 193 means

The payer took another look at the claim and found it was processed correctly the first time, so nothing changes.

This is the answer you get back after a reopening, reconsideration or similar request. The payer reviewed the claim again and stands by its first decision.

The code itself does not tell you why the claim was paid or denied. That reason sits with the earlier adjustment codes and any remark codes, so pull the original remittance alongside this one.

Group codes seen with 193

On a remittance, 193 comes after a group code. These are the ones it is most often reported with:

• CO 193 (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.
• PR 193 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.

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

• A reconsideration or reopening request did not include new information that changed the outcome.
• The provider asked for a review of a payment amount that already matched the payer's pricing.
• The appeal addressed a different issue than the one that drove the original adjustment.

What to do next

1. Pull the original remittance and identify the reason and remark codes that drove the first decision.
2. Decide whether you have new documentation or arguments that the first review did not see.
3. Check the payer's appeal levels and deadlines if you plan to take the claim further.
4. Close the account in your follow-up queue if the original decision was in fact correct.

Related codes

• 216 (reason code) Based on a review organization's findings
• 50 (reason code) Not medically necessary per the payer