CO · Contractual ObligationCARC 273

Denial Code CO-273

Q: What does CO-273 mean?

CO-273 is a Contractual Obligation (CO) denial: "Coverage/program guidelines were exceeded." The service went over the payer's coverage limit — a frequency cap, visit limit, dollar maximum, or benefit allowance was exceeded, so the amount beyond the limit was denied.

Q: Is CO-273 the patient's responsibility or a provider write-off?

CO-273 carries the CO group code (Contractual Obligation): Provider/contractual responsibility — not billable to the patient while denied. A CO adjustment is the provider's responsibility, not the patient's: balance-billing the patient for a CO amount is a contract (and often compliance) violation. But CO does not automatically mean “write it off.” When the cause is fixable — missing information (CO-16), a modifier problem (CO-4), or NCCI bundling (CO-97) — you correct and resubmit, or appeal with documentation. You only truly write the amount off when it is a final contractual adjustment, such as the fee-schedule difference on CO-45.

Coverage/program guidelines were exceeded.

Source: X12 Claim Adjustment Reason Codes (CARC) & Group Codes. Maintained by the D3rx Clinical Billing Team.

What CO-273 means

The service went over the payer's coverage limit — a frequency cap, visit limit, dollar maximum, or benefit allowance was exceeded, so the amount beyond the limit was denied.

Why CO-273 happens

An annual or per-period visit limit (e.g., therapy visits) was exceeded
A preventive/screening service billed more often than the covered frequency
A benefit dollar maximum or unit cap was reached
Lab or diagnostic testing beyond the covered frequency for the diagnosis

What to do when you get CO-273

1Check the patient's remaining benefits/limit for the service
2If the additional care was medically necessary, appeal with documentation supporting the overage
3If the limit is a hard benefit cap, determine whether the patient was on notice and is responsible
4Confirm the units/frequency billed were accurate (a keying error can look like an overage)

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CO group code: who absorbs the charge

Contractual Obligation — Provider/contractual responsibility — not billable to the patient while denied.

A CO adjustment is the provider's responsibility, not the patient's: balance-billing the patient for a CO amount is a contract (and often compliance) violation. But CO does not automatically mean “write it off.” When the cause is fixable — missing information (CO-16), a modifier problem (CO-4), or NCCI bundling (CO-97) — you correct and resubmit, or appeal with documentation. You only truly write the amount off when it is a final contractual adjustment, such as the fee-schedule difference on CO-45.

Appeal, correct, or write off CO-273?

Separate a true overage from a counting error. If units/frequency were keyed wrong, correct and resubmit. If care genuinely exceeded the limit but was medically necessary, appeal with the documentation justifying the additional services — though fixed benefit caps (e.g., one per lifetime/year) generally won't be overturned. Where the cap is a benefit limit and the patient was notified, the overage may be the patient's responsibility.

Timing & deadlines

Appeal within the payer's window (Medicare redetermination 120 days from the remittance; commercial ~180 days). Corrected claims (unit/frequency fix) follow timely-filing limits (Medicare 12 months from date of service; commercial ~90-180 days).

Example

A patient exceeds the plan's annual cap on therapy visits and the extra visits return CO-273. If continued therapy was medically necessary, appealing with the progress notes — or confirming the patient's responsibility for the capped overage — resolves the balance.

Prevent CO-273 going forward

Track per-period and once-per-lifetime services against the benefit limit per patient
Verify remaining benefits before delivering limit-sensitive care
Validate units/frequency at charge entry to avoid false overages
Notify patients in advance when care will exceed a covered limit

Code families most affected

Therapy and rehabilitation services with visit caps
Frequency-limited preventive and screening services
Benefit-capped diagnostics and procedures

Related codes

Denial codes you'll often see alongside CO-273

CO-272 CO-151

Payer notes

CO-273 (guidelines EXCEEDED) pairs with CO-272 (guidelines NOT met). Distinguish it from CO-151 (units not supported by documentation): CO-273 is about a coverage/benefit limit, not whether the record supports the units delivered.

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Medical billing disclaimer

CARC/RARC definitions are the standardized X12 set; group-code semantics follow the X12 Claim Adjustment Group Code standard. Filing and appeal windows vary by payer — the standard anchors shown (Medicare redetermination 120 days from the remittance; Medicare timely filing 12 months from date of service; most commercial payers ~90-180 days) are general references, not a guarantee for any specific plan. Always confirm the rule in the payer's provider manual before acting. D3rx is not responsible for claim outcomes.