Procedure code does not match the patient's age
The code billed is defined for a different age group than this patient.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- An age-specific code (for example a pediatric preventive visit 99381 to 99395 range, or a newborn code) billed for the wrong age.
- The patient's date of birth is wrong on the claim or in the payer's file.
The fix
Check the date of birth on the claim against the card. If the code is wrong, pick the age-appropriate code and send a corrected claim. If the payer has the wrong birth date, the patient must fix it with the plan.
Appeal or corrected claim?
Corrected claim when the code or date of birth is wrong. If the payer's record is wrong, reprocess after the patient updates it.
Deadline to watch
Timely filing limit.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-6 in short
What does CO-6 mean?
The code billed is defined for a different age group than this patient. The official X12 text reads: "The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."
What usually causes a CO-6 denial?
An age-specific code (for example a pediatric preventive visit 99381 to 99395 range, or a newborn code) billed for the wrong age. The patient's date of birth is wrong on the claim or in the payer's file.
How do I fix CO-6?
Check the date of birth on the claim against the card. If the code is wrong, pick the age-appropriate code and send a corrected claim. If the payer has the wrong birth date, the patient must fix it with the plan.
Should I appeal CO-6 or send a corrected claim?
Corrected claim. Corrected claim when the code or date of birth is wrong. If the payer's record is wrong, reprocess after the patient updates it.
What deadline applies to CO-6?
Timely filing limit.