OA 205 denial code
Claim adjustment reason code 205. Often reported as OA 205 or CO 205.
Pharmacy discount card fee
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 205 means
This amount is a processing fee charged for handling a pharmacy discount card transaction.
This one belongs to pharmacy claims processed through a discount card program rather than true insurance. The adjustment is the fee the card program takes for processing the transaction.
It is not a denial of the drug. It explains why the amount received is lower than the price the card program set.
Group codes seen with 205
On a remittance, 205 comes after a group code. These are the ones it is most often reported with:
- OA 205 (Other Adjustment): Used for adjustments that are neither the provider's contractual write-off nor the patient's share. It often appears with coordination of benefits, for example when another payer already paid.
- CO 205 (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 prescription was processed under a discount card program that charges a per-claim fee.
- The pharmacy's agreement with the card program includes a processing fee.
- A discount card was run instead of the patient's insurance.
What to do next
- Confirm the fee matches the pharmacy's agreement with the discount card program.
- Post the fee as an adjustment in the account set up for card program charges.
- Check whether the patient had insurance that should have been billed instead of the card.
Related codes
- 45 (reason code) Charge exceeds the allowed amount
- 212 (reason code) Administrative surcharge not covered
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
Last checked . Spotted a problem? Report a correction.