Non-covered charge(s) (Updated for 2026)

Common Causes for CO-96

Denials with code CO-96 typically happen for the following specific reasons:

• The billed procedure is explicitly listed as an exclusion in the patient's benefit plan contract, such as cosmetic, weight loss, or infertility treatments.
• The payer classifies the specific service, device, or drug as experimental, investigational, or not medically necessary under their current clinical guidelines.
• The service violates statutory exclusions, such as routine dental, vision, or hearing care under traditional Medicare plans without a specific benefit rider.
• The procedure was performed by an out-of-network provider under a strict HMO or EPO contract that offers zero out-of-network coverage.

How to Prevent CO-96 Denials

To avoid receiving this denial in the future, implement these specific checks:

• Conduct thorough real-time eligibility and benefit verification prior to rendering services to identify active plan exclusions.
• Utilize an Advance Beneficiary Notice of Noncoverage (ABN) for Medicare, or a commercial waiver, to ensure the patient is aware of financial responsibility before the service is performed.
• Review payer-specific medical policies, Local Coverage Determinations (LCDs), and National Coverage Determinations (NCDs) for coverage criteria before scheduling elective procedures.
• Incorporate automated scrubbing tools in the revenue cycle workflow to flag known non-covered codes based on patient plan types.

Appeal Letter Template for CO-96

If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.

[Your Practice Header]
[Date]

[Payer Name]
[Appeals Department Address]

RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO-96 - Non-covered charge(s)

Dear Appeals Department,

I am writing to appeal the denial of the above-referenced claim, which was denied with code CO-96: "Non-covered charge(s)".

We are writing to formally appeal the denial of the enclosed claim under code CO-96 (Non-covered charge). While we recognize the payer's standard policy regarding exclusions, the clinical documentation enclosed demonstrates that this specific service was medically necessary and represents the standard of care for the patient's severe pathological condition, differentiating it from elective or cosmetic treatments. According to CMS guidelines, exceptions to coverage policies must be considered when alternative treatments have failed and documentation supports clinical necessity. We respectfully request an administrative review of the attached clinical records, diagnostic reports, and peer-reviewed literature to overturn this denial and process the claim for payment.

Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].

We respectfully request that you reprocess this claim for payment.

Sincerely,

[Your Name]
[Title]
[Practice Name]