CO 289 denial code
Claim adjustment reason code 289. Often reported as CO 289 or PR 289.
Both dental and medical plans exclude it
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 289 means
Both the patient's dental and medical plans exclude this service, so neither one provides benefits for it.
Some services sit between dental and medical coverage. This code says that for this patient, both plans consider the service excluded, so sending it to the other plan will not help.
It is related to the routing codes 254, 270, and 280, but unlike those it does not point you to another plan.
Group codes seen with 289
On a remittance, 289 comes after a group code. These are the ones it is most often reported with:
- CO 289 (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 289 (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 service is a known exclusion under both the dental and medical policies.
- The service type falls between plans and neither one covers it.
- The plans coordinate on the service and both decline it.
What to do next
- Confirm the exclusion in both plans' benefit documents.
- Check whether a patient waiver or notice was signed before the service.
- Follow your contracts and the group code before moving any balance to the patient.
Related codes
- 254 (reason code) Dental plan: bill the medical plan
- 270 (reason code) Medical plan: bill the dental plan
- 280 (reason code) Medical plan: bill the pharmacy plan
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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