Denial codes / CO-204
Denial code 204CO-204: Not covered under the current plan
Service not covered under the patient's current benefit plan.
What to doRead the EOB, then decide
Often recoverableUsually not
The letters in front matter. CO means the office can't bill the patient for the amount; PR means the patient may owe it. The same number can appear with either, so read both parts.
Why dental offices see it
- The patient's current plan does not include this service.
What to do
- Verify benefits.
- If covered, appeal with plan language; otherwise the patient may owe, depending on your agreement.
Stop it next time
Verify benefits for the specific procedure before treatment.
How many CO-204 claims are in your report? The free check counts them, ranks them by dollars and deadline and drafts the letter. It runs in your browser; nothing is uploaded.
Plain-English paraphrase; the official code list is maintained by X12. Insurer rules vary; check the insurer's provider manual. Not legal advice.