CO-274 says the payer already pays someone else to coordinate this patient’s care. A medical home, an accountable care group or a care management program may get a set fee for that work. When another claim bills for the same kind of service, the payer denies it under the arrangement. (Primary source: X12 Claim Adjustment Reason Codes)
In brief: CARC 274 reads “Fee/Service not payable per patient Care Coordination arrangement.” Find out who holds the arrangement, check whether your service is inside it, and stop billing that service if it is.
Part of our denial codes library. Written by Manikandan J, CPC, CRCR, who has worked care management and value-based contract denials for primary care groups. Published 24 October 2026. Last updated: 24 October 2026. Code wording quoted word for word from X12. Read about the author and our editorial policy, or contact us to report an error.
What X12 says
| Field | Value |
|---|---|
| Code | 274 |
| Description | “Fee/Service not payable per patient Care Coordination arrangement.” |
| Start | 11/01/2014 |
Source: X12 Claim Adjustment Reason Codes, checked 24 October 2026.
Key terms: A CARC is a Claim Adjustment Reason Code from the X12 list, and it says why a line was paid differently than billed. A RARC is a Remittance Advice Remark Code that adds detail to the CARC. The group code is the two-letter prefix on the adjustment; CO means contractual obligation: the provider owns the balance and it cannot be billed to the patient.
Methodology: the code wording above is copied from the X12 list, and each fix step below links to the payer or CMS page it comes from.
Example scenario (fictional names), part 1
CO-274 Denial Example: What Happened
Leo Grant bills for Northside Cardiology, a fictional practice. The team started monthly care management calls for a heart failure patient.
The care management claim came back with CAS*CO*274.
Who is already being paid for this work? Keep reading, or jump to how the CO-274 denial was resolved.
Common triggers
- A medical home fee. The patient’s primary care practice gets a monthly fee that covers care coordination.
- Two practices doing care management. For example, Medicare’s chronic care management booklet says only 1 practitioner can bill CCM for a patient in a calendar month. Commercial plans often have similar rules.
- Value-based contracts. An accountable care group may hold the care coordination part of the patient’s care.
- Program enrollment. The patient joined a plan care program that does this work in-house.
Steps to sort it out
- Ask the payer who holds it. Get the name of the practice or program with the arrangement.
- Check what’s inside. Read the arrangement terms or the payer policy. Visits and tests are often still billable.
- Talk to the other practice. Agree who does care management, so the patient isn’t billed twice.
- Stop or switch. If your service is inside the arrangement, stop billing it. If it isn’t, appeal with the terms.
- Ask at intake. Ask patients if another office already runs their care plan.
A CO amount generally stays with the provider. Check your contract before you move any balance.
Claim form note
No claim form visual is shown. CO-274 turns on who holds the care coordination arrangement, not on a field on the CMS-1500 or UB-04.
Example scenario (fictional names), part 2
How the CO-274 Denial Was Resolved
Leo called the payer and learned the patient’s primary care practice already billed care management that month.
Fix: The two practices agreed the primary care office would keep care management. Leo wrote off the denied line and kept billing the cardiology visits.
Outcome: No more CO-274 denials. Northside now asks every new patient whether another office runs their care plan.
Names and details are illustrative; no real patient data.
Related codes
| Code | Meaning | Fix |
|---|---|---|
| CO-274 | Care coordination arrangement | Find who holds it |
| CO-18 | Duplicate claim or service | Check for a repeat |
| CO-96 | Non-covered charge | Check plan rules |
| CO-16 | Claim data missing | Add the missing item |
FAQ
What does CO-274 mean?
The fee or service is already paid through the patient’s care coordination arrangement with another provider or program.
Are office visits affected by CO-274?
Usually not. It mostly hits care management or coordination fees, not the visits themselves.
Can I appeal CO-274?
Yes, when your service falls outside the arrangement’s terms. Send the terms with the appeal.
Can the patient be billed?
No. A CO amount is generally the provider’s to absorb.
How do I avoid CO-274?
Ask patients and the payer whether a care coordination arrangement already exists before you start care management.
Sources
How we checked: the code quote was matched word for word with the X12 CARC list, and the CCM rule with the CMS booklet, both on 24 October 2026.
- X12, Claim Adjustment Reason Codes (CARC 274). Accessed 24 Oct 2026.
- CMS, Chronic Care Management Services booklet (MLN909188). Accessed 24 Oct 2026.
- CMS, Care Management. Accessed 24 Oct 2026.
Last updated: 24 October 2026 ยท Educational content; not legal advice.
Related denial codes
- CO-267: Claim Spans Multiple Months
- CO-249: Claim Identified as a Readmission
- CO-239: Rebill Separate Claims by Coverage Period
- CO-233: Hospital-Acquired Conditions
- CO-232: Institutional Transfer Amount
- CO-190: Payment Included in the SNF Qualified Stay
- CO-186: Level of Care Change Adjustment
- CO-135: Interim Bills Cannot Be Processed