CO 274 denial code

Claim adjustment reason code 274. Often reported as CO 274.

Not payable under care coordination

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 274 means

The fee or service is not payable under the care coordination arrangement the patient is enrolled in.

Patients in care coordination programs, such as some medical home or managed arrangements, have services organized and often paid through that program. This code says the fee or service on the claim is not one the arrangement pays separately.

It may mean the service is covered by a care management fee already paid, or that it falls outside the arrangement.

Group codes seen with 274

On a remittance, 274 comes after a group code. These are the ones it is most often reported with:

• CO 274 (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 service is included in a care coordination or care management payment.
• The provider billing is not the coordinating provider for the patient.
• The fee billed is not part of what the arrangement pays.

What to do next

1. Check whether the patient is attributed to a care coordination program and to which provider.
2. Review the program terms for which services are paid separately.
3. Appeal or correct the claim if the patient was not in the program on the date of service.

Related codes

• 256 (reason code) Not payable under managed care contract
• 97 (reason code) Service included in another payment