CO-48: Non-Covered Service Under State Law
CO (Contractual Obligation)What is CO-48?
CO-48 is a Contractual Obligation code indicating the service is not covered under the applicable state law or regulation. The state where the service was rendered has restrictions that prevent coverage of the billed service.
Why Does CO-48 Occur?
- State-mandated exclusion for the specific service.
- Service not licensed in the state where it was rendered.
- State regulation requires a specific condition that was not met (e.g., supervision requirements for certain providers).
How to Fix CO-48 Denials
- Identify the specific state regulation that applies from the RARC code or by contacting the payer.
- If the service meets state requirements, appeal with documentation of compliance.
- If the state law actually prevents coverage, inform the patient of their responsibility.
- For telehealth claims, verify the service is licensed in both the provider's and patient's state.
CO-48 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | Varies | 60 days from remittance | Reconsideration required before formal appeal. |
| Anthem | Varies | 365 days from denial notice | Check state-specific provider manual for variations. |
| Aetna | Varies | 180 days from denial | Strict in-network filing enforcement. |
| Cigna | Varies | 180 days from denial | Cigna COB team: 1-800-244-6224. |
| Medicare | Varies | 120 days (redetermination at MAC) | Five levels of appeal starting with MAC redetermination. |
Related CARC Codes
If you are seeing CO-48, check these related codes: CO-16 (claim differs), CO-45 (fee schedule), CO-29 (timely filing).
Common Questions About CO-48
What does CO-48 mean?
CO-48 indicates non-covered service under state law. Check the RARC code on the EOB for the specific reason and follow the resolution steps above.
Can I appeal a CO-48 denial?
Yes. Commercial payers allow 60-365 days to appeal depending on the payer. Gather supporting documentation before filing. Medicare allows 120 days for a redetermination request.
Altair catches CO-48 denials before submission with state regulation compliance. See how pre-submit claim scoring works.