CO-96 Denial — How to Appeal for Behavioral Health
CO-96 (non-covered charges) is one of the most common insurance denial codes behavioral health therapists encounter. This guide explains what triggered the denial and the most effective appeal strategy across all major payers.
What CO-96 means
The service is not covered under the patient's specific plan. This is different from CO-50 (not medically necessary) — CO-96 means the plan documents simply exclude the benefit.
Appeal strategy for CO-96
Review the member's Summary of Benefits and Coverage (SBC) and the full plan document. If the service should be covered, cite the exact plan language. If it is genuinely excluded, confirm whether any ACA essential health benefit or MHPAEA parity requirement overrides the exclusion. Non-covered behavioral health services may still be required to be covered if the plan covers analogous medical services.
CPT codes commonly denied with CO-96
Appeal CO-96 by payer
Select your payer for appeal address, deadline, and payer-specific MHPAEA notes.
Generate your CO-96 appeal letter in 60 seconds
First 5 letters free. No credit card. MHPAEA arguments included when applicable.
Generate my appeal letter →Frequently asked questions about CO-96
What does CO-96 mean on a behavioral health claim?
The service is not covered under the patient's specific plan. This is different from CO-50 (not medically necessary) — CO-96 means the plan documents simply exclude the benefit.
How do I appeal a CO-96 denial?
Review the member's Summary of Benefits and Coverage (SBC) and the full plan document. If the service should be covered, cite the exact plan language. If it is genuinely excluded, confirm whether any ACA essential health benefit or MHPAEA parity requirement overrides the exclusion. Non-covered behavioral health services may still be required to be covered if the plan covers analogous medical services.
Does MHPAEA apply to CO-96 denials?
CO-96 is a general adjudication code that typically applies equally to all claim types. MHPAEA may still be relevant if the payer applies the underlying rule differently to mental health services than to comparable medical/surgical services.
Which insurers most commonly issue a CO-96 denial?
All major commercial payers — Aetna, Cigna, Anthem, UnitedHealthcare, Humana, and BCBS plans — use CO-96. Government programs (Medicare, Medicaid, TRICARE) also issue this code. The appeal strategy is similar across payers, but deadlines and submission addresses vary. Select your payer from the list below for payer-specific instructions.