CO 264 denial code
Claim adjustment reason code 264. Often reported as CO 264.
Drug postage cost adjustment
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 264 means
A pharmaceutical claim was adjusted for postage costs, a code that applies only to pharmacy claims.
This pharmacy pricing code identifies an adjustment tied to postage for mailing the medication. Payers keep postage, shipping, and delivery as separate reasons so the pharmacy can see which charge was touched.
It is used only on pharmaceutical claims, typically mail order fills.
Group codes seen with 264
On a remittance, 264 comes after a group code. These are the ones it is most often reported with:
- CO 264 (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
- Postage was billed for a mail order fill and the contract prices it differently.
- The plan does not reimburse postage separately for that drug.
- The postage amount billed exceeded what the contract allows.
What to do next
- Review the pharmacy agreement for postage reimbursement terms.
- Make sure postage was not also billed as shipping or delivery on the same claim.
- Follow up with the pharmacy benefit manager if the adjustment looks wrong.
Related codes
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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