CO-204 Denial Code
What it means
The item simply isn't a covered benefit under your specific plan.
Why it happens
The service/drug/device is excluded from your plan's benefits.
What to do
Check your Summary of Benefits. If it should be covered (or is required by a mandate), appeal. If truly excluded, ask about a formulary exception or alternative covered option.
Can you appeal it?
Sometimes - via exception or mandate argument.
Official description
This service/equipment/drug is not covered under the patient's current benefit plan.
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