Denial Code 204 (CO-204, PR-204) — Meaning & What to Do
Claim Adjustment Reason Code (CARC)
What denial code 204 means: This service isn't covered under your current benefit plan.
What to do about denial code 204: Check your plan documents; appeal if you believe it's covered.
CO-204 vs PR-204 vs OA-204: what the prefix means
| Code on your EOB | What the prefix means | Who typically pays |
|---|---|---|
| CO-204 | Contractual obligation — the provider writes the amount off | Usually not the patient |
| PR-204 | Patient responsibility | The patient |
| OA-204 | Other adjustment | Often another payer or plan |
The prefix tells you who is expected to absorb the amount; the number (204) tells you why.
Related codes
CARC 197Pre-authorization or pre-certification was required but not obtained.
CARC 252Additional documentation is needed to process the claim.
CARC 119A benefit maximum or limit for this service has been reached.
CARC 5The procedure code doesn't match the place where the service was given.
Keep reviewing your bill
- Medical Bill vs EOB: What Is the Difference?
- How to Dispute a Medical Bill — Find Billing Errors Before You Pay
Frequently asked questions about Denial code 204
What does denial code 204 mean on my EOB?
This service isn't covered under your current benefit plan.
What should I do about denial code 204?
Check your plan documents; appeal if you believe it's covered.
Found this code on your bill or EOB?
Upload the document — MD Bill Check decodes every code, checks the math line by line, and explains what's worth questioning.