CO 272 denial code

Claim adjustment reason code 272. Often reported as CO 272.

Coverage or program guidelines not met

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 272 means

The service did not meet the plan's coverage or program guidelines, so it was not paid as billed.

This is a broad code that says the claim fell short of a coverage rule or program requirement. Because it is general, the remark codes and any policy reference on the remittance are the only way to tell which rule was missed.

Typical examples are clinical criteria, required steps in a program, or conditions the plan attaches to a benefit.

Group codes seen with 272

On a remittance, 272 comes after a group code. These are the ones it is most often reported with:

• CO 272 (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 patient did not meet the clinical criteria in the plan's coverage policy.
• A required program step, such as enrollment or prior therapy, was not completed.
• The documentation did not show the conditions the policy requires.

What to do next

1. Read the remark codes and any policy number on the remittance.
2. Pull the payer's coverage policy and compare it with the patient's records.
3. Appeal with records that show the guidelines were met, or correct the claim if it was billed wrong.

Related codes

• 273 (reason code) Coverage or program guidelines exceeded
• 50 (reason code) Not medically necessary per the payer
• 96 (reason code) Service not covered by the plan