835 Denial Combination
CO-49
Contractual Obligation · Service-Line Level Adjustment
Contractual ObligationWhat This Combination Means
The payer has determined that the service billed is a routine or preventive exam, or a diagnostic/screening procedure performed alongside preventive care, which is non-covered under the patient's benefit plan. Because this is a contractual obligation adjustment, the provider must write off the denied amount and cannot transfer the balance to the patient.
Financial Responsibility
provider writeoff
The provider must absorb the full adjusted amount as a contractual write-off per the payer agreement. The patient has no financial liability for this non-covered preventive or screening service.
N/A
Appeal Success
Immediate (write-off)
Avg. Resolution
Easy
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-49 combination — not generic advice.
- 1
Verify the service billed was indeed routine/preventive or a screening procedure
Confirm that CPT codes submitted align with preventive or screening service definitions that triggered this non-coverage determination
- 2
Check the patient's benefit plan for preventive service coverage limits
Determine if the plan excludes routine exams or has annual frequency limitations that were exceeded
- 3
Post the contractual adjustment as a provider write-off in the billing system
Ensure the patient account reflects zero patient responsibility and close the claim with appropriate adjustment codes
Specialty Context
How CO-49 typically presents across different practice types.
Dental
Common for routine cleanings, exams, or X-rays that exceed plan frequency limits (e.g., two cleanings per calendar year already used) or are billed as diagnostic but performed during preventive visits.
Medical
Frequently occurs when screening procedures (colonoscopy, mammogram, lab panels) are billed with diagnostic codes instead of screening codes, or when annual preventive visit limits have been exhausted.
Behavioral Health
May apply to routine mental health screenings or assessments performed as part of preventive wellness visits that are not separately reimbursable under the benefit structure.
Individual Code References
View the standalone definition for each code in this combination.
Medicare Contractor Guidance for CARC 49
FCSOThe denial was received because the service is a routine or preventive exam, or diagnostic / screening procedure done in conjunction with a routine or preventative exam. Diagnostic / screening procedures and evaluation and management (E/M) services for routine or screening purposes, such as an annual physical, are not covered by Medicare.
How to Prevent CARC 49 Denials
- ✓
Medicare does cover certain preventive services, including an Initial Preventive Physical Examination (IPPE) and an Annual Wellness Visit (AWV). Review preventive services for information on covered preventive services, including coding and billing.
Need to resolve this denial?
Get a complete resolution plan with appeal guidance for this exact combination in seconds.
Generate a free resolution plan & appeal letter →Synthesized from official definitions — not from training data