The CO-292 denial code means the medical plan would not pay for the drug and forwarded the claim to the patient’s pharmacy plan. You do not need to refile yet. Confirm that the pharmacy plan received it, answer any questions, and watch for its decision. (Primary source: X12 Claim Adjustment Reason Codes)
In brief: CARC 292 is a routing notice for drugs. The twin code, CARC 280, means the medical plan did not forward the claim, so you must send it to the pharmacy plan. With CO-292, track the claim and do not bill the patient yet.
Part of our denial codes library. Written by Manikandan J, CPC, CRCR, who has worked drug-benefit handoffs for women’s health and infusion clinics. Published 14 November 2026. Last updated: 14 November 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 does denial code CO-292 mean?
Denial code CO-292 means the medical plan paid nothing on the drug line and moved the claim to the pharmacy plan. Reason code 292 appears when one carrier runs both benefits. The medical zero is not the last word on the drug.
| Field | Value |
|---|---|
| Code | 292 |
| Description | “Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient’s pharmacy plan for further consideration.” |
| Group codes | No X12 group restriction; CO and OA both appear |
| Start | 11/01/2017 |
| X12 note | Use CARC 280 if the claim was not forwarded |
Source: X12 Claim Adjustment Reason Codes, checked 14 November 2026.
Methodology: the code wording is copied from the X12 list, and the claim form steps follow the NUCC instructions cited below.
Key terms: The pharmacy benefit covers drugs the patient gets through a pharmacy, often with a separate manager. The medical benefit covers drugs given in the office. CO is the contractual obligation group code.
CO-292 vs OA-292: what is the difference?
CO-292 books the medical zero as a contract adjustment while the drug claim moves to the pharmacy side. OA-292 reports the same transfer with no one named as liable. Either way, the pharmacy plan decides next, and the patient owes nothing yet.
| Version | How to post the medical remittance | What to wait for |
|---|---|---|
| CO-292 | Zero pay on the drug line, hold in a forwarded-to-pharmacy status | The pharmacy plan’s response |
| OA-292 | Same posting, no liability named | The pharmacy plan’s response |
Keep the administration fee on its own line, because the plan may process the injection service separately from the medication itself.
Why did the medical plan forward the claim to pharmacy?
The medical plan forwards a drug claim when the plan covers that drug only under the pharmacy benefit. Many self-administered or specialty medications are handled in exactly this way. The plan finds its medical benefit does not apply, so it sends the line to the pharmacy plan.
Forwarding needs the plan to know the patient’s pharmacy coverage. If it cannot forward, you get CARC 280 and must handle the drug claim yourself, as the X12 note on CARC 292 says.
Example scenario (fictional names), part 1
CO-292 Denial Example: What Happened
Tomás Reyes does billing for Larkspur Women’s Health. Nurse practitioner Dana Whitfield gave a medroxyprogesterone injection for contraception. Tomás billed J1050 for 150 units, 96372 for the injection and Z3042 as the diagnosis.
The fictional plan runs both the medical and pharmacy benefits.
The 835 showed CAS*CO*292 on the J1050 line with zero paid. The 96372 line paid. The front desk asked whether the patient should pay for the drug.
Should Tomás refile the drug line, or wait? Keep reading, or jump to how it was resolved. Keep reading, or jump to how the CO-292 denial was resolved.
How do I handle a CO-292 denial?
To handle a CO-292 denial, post the zero, hold the drug balance and track the claim at the pharmacy plan. Call to confirm receipt and get the new claim number. If the pharmacy plan has no record, send the drug claim through the pharmacy route that the plan names.
- Post and hold. Record the zero on the drug line and flag it as forwarded to pharmacy.
- Confirm receipt. Ask the pharmacy plan for the new claim number.
- Check drug rules. Ask whether the drug must come from a specialty pharmacy.
- File only if lost. If there is no claim, follow the pharmacy route the plan names.
- Work the pharmacy decision. Treat a pharmacy denial as a new denial.
Example scenario (fictional names), part 2
How the CO-292 Denial Was Resolved
Tomás called the pharmacy plan. It had the forwarded line, but it asked for the drug’s national code and the days of supply, which the medical claim had not carried.
Fix: he sent the dispensing details the plan listed and quoted the new claim number. He left the paid 96372 line alone and did not resend J1050, which would have created a duplicate. He told the front desk to hold the patient bill.
Outcome: the pharmacy plan approved the drug. Tomás now checks each new patient’s drug benefit before the first injection day, and he posts a 14-day follow-up on every CO-292.
Names and details are illustrative; no real patient data.
Names and details are illustrative; no real patient data.
Will refiling after CO-292 cause a duplicate denial?
Yes, resending the drug line can cause a duplicate denial. The pharmacy plan already holds the forwarded claim, so a second submission can return as an exact duplicate, such as CO-18. Check the status first. Resend only when the plan confirms it has no record.
Can I bill the patient for CO-292?
No, not while the pharmacy plan is deciding. CO-292 is a contractual zero on the medical side, not patient responsibility. Wait for the pharmacy response. For example, a copay or deductible may show later as PR, as the HealthCare.gov copayment definition describes.
Related codes
| Code | Meaning |
|---|---|
| CO-280 | Medical plan: submit to the pharmacy plan yourself |
| CO-291 | Medical plan: forwarded to the dental plan |
| CO-270 | Medical plan: submit to the dental plan yourself |
| CO-18 | Exact duplicate claim or service |
FAQ
What does CO-292 mean?
The medical plan found no benefit and forwarded the claim to the pharmacy plan.
Do I need to refile a CO-292 claim?
Not at first. Confirm the pharmacy plan received it, and resend only if it did not.
Is CO-292 the same as CO-280?
No. CO-280 means the claim was not forwarded. CO-292 means it was.
Which group code comes with CARC 292?
X12 sets no restriction. CO and OA both appear on medical remittances.
Does the patient owe a CO-292 amount?
No. Wait for the pharmacy plan’s decision before billing anything.
Sources
How we checked: the CARC 292 quote was matched word for word with the X12 CARC list on 14 November 2026, including the X12 note pointing to CARC 280.
- X12, Claim Adjustment Reason Codes (CARC 292, 280, 18). Accessed 14 Nov 2026.
- X12, Remittance Advice Remark Codes. Accessed 14 Nov 2026.
- NUCC, 1500 claim form instructions. Accessed 14 Nov 2026.
- HealthCare.gov, copayment definition. Accessed 14 Nov 2026.
- HealthCare.gov, prescription drugs definition. Accessed 14 Nov 2026.
Last updated: 14 November 2026 · Educational content; not legal advice.