Claim adjustment reason code
Denial code CO-40 meaning
CARC 40, usually seen as CO-40: The payer decided the visit did not meet its rules for emergency or urgent care.
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- Reason code
- CARC 40
- Short name
- Not an emergency or urgent visit
- Plain meaning
- The payer decided the visit did not meet its rules for emergency or urgent care.
- Group codes
- CO-40: Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
Plain-English summary written by Rivvi. X12 owns the CARC list and its exact wording, which is not reproduced here. Read it on the X12 CARC list (list dated November 1, 2025, checked October 23, 2026). This page does not decide how a claim is paid.
Common causes
- The diagnosis billed does not show an emergency under the payer's policy.
What to check before resubmitting
- Check that the diagnosis codes reflect the symptoms that brought the patient in.
- Appeal with the record if the visit met the prudent layperson standard.
Related reason codes
Related pages
Questions
What does denial code CO-40 mean?
The payer decided the visit did not meet its rules for emergency or urgent care. This is Rivvi's plain-English summary of CARC 40. X12's exact wording is on x12.org.
How do I fix CO-40?
Check that the diagnosis codes reflect the symptoms that brought the patient in. Appeal with the record if the visit met the prudent layperson standard.
Can I bill the patient for CO-40?
With group code CO, no. CO means the provider absorbs the amount under its contract or the payer's rules.
Which group codes come with CARC 40?
Most often CO (contractual obligation). The group code, not the reason code, says who owes the amount.
What is the difference between a CARC and a RARC?
A claim adjustment reason code (CARC) says why a claim line was paid differently than billed. A remittance advice remark code (RARC) adds detail, such as which field is missing.