CO 76 denial code
Claim adjustment reason code 76. Often reported as CO 76.
Low-income patient load 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 76 means
The inpatient payment was adjusted for the hospital's status as a provider serving many low-income patients.
Hospitals that treat a high share of low-income patients often receive an extra percentage on inpatient payments. This code shows that disproportionate share amount on the individual claim.
It is a payment component, not a denial. If it is missing or smaller than expected, the cause is usually the hospital's percentage on the payer's rate file rather than anything on the claim itself.
Group codes seen with 76
On a remittance, 76 comes after a group code. These are the ones it is most often reported with:
- CO 76 (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 hospital qualifies for a disproportionate share add-on under the payer's method.
- The payer recalculated the hospital's percentage for a new period.
- The payer's contract excludes or limits the add-on for some claim types.
What to do next
- Check the add-on amount against the percentage your reimbursement team expects for the period.
- Raise rate file errors with the payer's provider relations or rate setting contact.
- Post the line as part of the expected payment rather than as a write-off or denial.
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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