Past the plan or program limit headline with a KX exception card and a check exceptions card

CO-273 Denial Code (CARC 273) 2026: Coverage Guidelines Exceeded

CO-273 is the “too much” partner of CO-272. The service went past a limit the plan or program sets. That limit can be a visit count, a dollar threshold, a quantity or a time frame. Some limits are hard stops. Others have an exception path, and that’s where most of these get paid. (Primary source: X12 Claim Adjustment Reason Codes)

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In brief: CARC 273 reads “Coverage/program guidelines were exceeded.” Find the limit, check whether the plan has an exception for medical need, and resubmit with the exception shown, such as the KX modifier on Medicare therapy above the yearly threshold.

Part of our denial codes library. Written by Manikandan J, CPC, CRCR, who has fixed therapy threshold and visit-limit denials for outpatient clinics. 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.

Code details

FieldValue
Code273
Description“Coverage/program guidelines were exceeded.”
Start11/01/2014

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-273 Denial Example: What Happened

Nadia Ross bills for Riverbend Physical Therapy, a fictional clinic. A patient recovering from knee surgery kept up therapy into the autumn.

A new line came back with CAS*CO*273. The patient’s yearly therapy total had passed the threshold.

Is this a hard stop, or can Nadia fix it? Keep reading, or jump to how the CO-273 denial was resolved.

Kinds of limits behind CO-273

  • Dollar thresholds. For example, CMS sets the 2026 KX threshold at $2,480 for PT and SLP combined, and $2,480 for OT. CMS says claims above it without the KX modifier are denied.
  • Visit counts. Many plans cap therapy, chiropractic or behavioral visits per year.
  • Quantity limits. Supplies, drugs and tests can have per-month or per-year caps.
  • Time frames. Some services are covered only within a set window.

Payers word limit denials in different ways. CO-273 is one of the codes used when a stated limit is passed.

Getting past the limit, the right way

Limit exceeded steps: name the limit, check for an exception, document the need, resubmit with KX
  1. Name the limit. Check the remit RARC and the plan’s benefit summary.
  2. Check for an exception. Medicare therapy allows the KX modifier when care above the threshold is medically needed and documented.
  3. Document the need. The plan of care and progress notes should show why therapy must go on.
  4. Resubmit with the exception. Add KX in Box 24D on the CMS-1500, or with the HCPCS code in FL 44 on the UB-04.
  5. Watch the next tier. CMS still runs targeted medical review above $3,000.

Our guide on medical necessity documentation covers what the notes should show.

Claim form before and after

[[CFV]]

Example scenario (fictional names), part 2

How the CO-273 Denial Was Resolved

Nadia read the progress notes before adding anything.

Fix: The notes showed steady gains and a clear goal. She corrected the line to GP KX and resubmitted as a replacement claim.

Outcome: The line paid. The clinic now tracks each patient’s yearly therapy total, so KX goes on the first line above the threshold.

Names and details are illustrative; no real patient data.

CO-273 CMS-1500 excerpt adding the KX modifier in Box 24D to a therapy line above the yearly threshold
Example (fictional data): progress notes support therapy past the threshold, so the corrected line carries GP KX.
CO-273 UB-04 claim form adding KX to the FL 44 therapy code on a replacement outpatient bill
Example (fictional data): the hospital outpatient bill shows the same exception in FL 44, sent as type of bill 0137.
  • Box 24D / FL 44: KX added after GP on 97110, because the notes show therapy above the threshold is needed.
  • Box 22 / FL 4 + FL 64: code 7, or type of bill 0137, with the original claim number.
  • Box 21 / FL 67: Z47.1 (entered as Z471) and Z96.651 are unchanged.
  • Box 24F / FL 47: charges are unchanged.
  • Records: plan of care and progress notes stay on file for review.
CodeMeaningFix
CO-273Limit exceededException proof
CO-272Program rule not metProof the rule was met
CO-4Modifier problemFix the modifier
CO-50Not medically necessaryRecords of need

FAQ

What does CO-273 mean?

The service went past a coverage or program limit, such as a visit count or dollar threshold.

Can I just add KX to get paid?

No. KX is a statement that the care is medically needed and documented. Only use it when the record supports that.

Is the KX threshold a cap?

No. It’s a threshold. Care above it can be paid with KX when it’s medically needed.

Does CO-273 always involve therapy?

No. Any limit, such as supplies or visits, can trigger it.

Can the patient be billed?

Not for a CO amount, unless the plan allows it and a valid notice was signed before the service.

Sources

How we checked: the code quote was matched word for word with the X12 CARC list, and the 2026 threshold with the CMS therapy services page, both on 24 October 2026.

Last updated: 24 October 2026 · Educational content; not legal advice.

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