Denial codes / CO-96
Denial code 96CO-96: Not covered
Non-covered charge(s).
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 plan excludes the procedure (for example implants or cosmetic services).
- The wrong code was used for a covered service.
What to do
- Check the plan's exclusions.
- If the code was wrong, correct and resend.
- If the plan covers it, appeal with the benefit language.
Stop it next time
Verify coverage for major procedures before treatment and get a pre-treatment estimate.
How many CO-96 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.