CO 260 denial code

Claim adjustment reason code 260. Often reported as CO 260.

Paid under Medicaid ACA enhanced fees

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 260 means

The claim was priced using the Medicaid enhanced fee schedule created under the Affordable Care Act for certain services.

The ACA raised Medicaid payment for certain primary care services to Medicare levels for eligible providers for a period of time. This code tells you the claim was priced with that enhanced schedule rather than the standard Medicaid rates.

It explains how the payment was figured rather than signaling a problem. It is mostly seen on older Medicaid remittances, and how a state applies it depends on its own program rules.

Group codes seen with 260

On a remittance, 260 comes after a group code. These are the ones it is most often reported with:

• CO 260 (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 provider was attested as eligible for the enhanced Medicaid primary care rate.
• The service was one of the primary care codes covered by the enhanced schedule.
• The date of service fell in a period when the state applied the enhanced rates.

What to do next

1. Check that the paid amount matches the enhanced rate for the code and date of service.
2. Post any remaining difference according to the Medicaid contract.
3. Check the state Medicaid policy if the enhanced rate seems applied to the wrong services.

Related codes

• 45 (reason code) Charge exceeds the allowed amount