CO 254 denial code
Claim adjustment reason code 254. Often reported as CO 254 or OA 254.
Dental plan: bill the medical plan
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 254 means
Send these services to the patient's medical insurance; the dental plan reviewed them and found they are not dental benefits.
The claim went to the dental side of coverage, and the payer decided the service is medical rather than dental. It did not send the claim on to the medical plan for you; that is what code 290 would say.
This is a routing problem, not a final denial of the service. The next step is usually to bill the patient's medical carrier with the right claim form and codes.
Group codes seen with 254
On a remittance, 254 comes after a group code. These are the ones it is most often reported with:
- CO 254 (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 254 (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
- Oral surgery, trauma, or a medically related procedure was billed to the dental plan.
- The service is covered under the patient's medical policy instead of the dental policy.
- The office used the dental carrier by default without checking which plan covers the service.
What to do next
- Verify the patient's medical coverage and whether the medical plan needs prior authorization for the service.
- Rebill on the medical claim format with medical diagnosis and procedure codes.
- Keep the dental remittance in case the medical plan asks for proof that the dental plan denied first.
Related codes
- 290 (reason code) Dental plan forwarded to medical plan
- 289 (reason code) Both dental and medical plans exclude it
- 270 (reason code) Medical plan: bill the dental plan
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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