CO 223 denial code
Claim adjustment reason code 223. Often reported as CO 223 or OA 223.
Mandated adjustment with no specific code
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 223 means
A federal, state or local law requires this adjustment, and no dedicated reason code exists for it yet.
Payers use this as a placeholder when a law forces an adjustment that the code set does not yet describe on its own.
Because the code is generic, the remark codes and any payer notice matter more than usual. They should explain which law applies.
Group codes seen with 223
On a remittance, 223 comes after a group code. These are the ones it is most often reported with:
- CO 223 (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.
- OA 223 (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.
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 new state or federal mandate changed how the claim must be paid.
- A legislated adjustment applied that has no matching reason code.
- A temporary regulatory change affected claims for a period.
What to do next
- Read the remark codes and any payer bulletin for the specific law behind the adjustment.
- Confirm the adjustment amount is consistent with that law.
- Contact the payer for an explanation if no remark code explains it.
Related codes
- 237 (reason code) Legislated or regulatory penalty
- 45 (reason code) Charge exceeds the allowed amount
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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