CO-272 — Coverage / program guidelines not met
Claim-adjustment reason code 272 · typically reported as CO-272
What it means
A general policy-criteria denial: something in the payer’s coverage guidelines wasn’t satisfied (read remark codes + the policy to find which element).
Why DME claims hit it
- LCD/policy-article requirements (testing thresholds, trial periods, supervised use) not evidenced
- Program-integrity rules like supplier-standards conditions
How to fix it
- Identify the exact unmet guideline from the policy text; cure it (documentation or process) and appeal/resubmit per the payer’s instruction
Appeal posture
Yes, when you can map evidence to each guideline element.
Related denial codes
CO-50 — Not deemed medically necessaryCO-226 — Requested records not received from providerCO-273 — Coverage guidelines exceeded
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