CO-204Contractual Adjustment
Service or supply not covered by the plan
What this code means
This specific service or supply is listed as excluded in your plan. It is a broader exclusion than CO-96.
What to do next
Check your plan exclusions list in your Summary of Benefits. If the exclusion seems incorrect or you believe a state mandate applies, appeal citing the specific coverage requirement. Request the exact plan language used to deny the claim.
Appeal outlook: Low to moderate
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