CO 273 denial code
Claim adjustment reason code 273. Often reported as CO 273 or PR 273.
Coverage or program guidelines exceeded
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 273 means
The service went beyond what the plan's coverage or program guidelines allow, such as more visits, units, or frequency.
Where code 272 says a requirement was not met, this one says a limit was passed. The plan covers the service up to a point, and this claim went over it.
Look at remark codes and policy references to find the limit that applied. Whether the patient can be billed depends on the group code and any waiver or notice rules in your contract.
Group codes seen with 273
On a remittance, 273 comes after a group code. These are the ones it is most often reported with:
- CO 273 (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.
- PR 273 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.
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 number of visits, units, or services passed the plan's guideline.
- Services were given more often than the program allows.
- Earlier services, possibly from other providers, used up the allowed amount.
What to do next
- Identify the limit from the remark codes or policy reference.
- Check whether an exception or extension can be requested with clinical support.
- Review your contract and any patient notice signed before deciding where the balance goes.
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.
Last checked . Spotted a problem? Report a correction.