CO-269: Anesthesia Not Covered for This Service

What Does CO-269 Mean?

CO-269 designates the anesthesia charge as a contractual write-off. The payer's coverage guidelines do not include anesthesia for this procedure under your contract, and the charge cannot be billed to the patient. This is the most common pairing and typically means the payer considers the procedure a minor or office-based service that does not warrant separate anesthesia billing.

When CARC 269 appears on a remittance, the payer has determined that anesthesia services are not a covered benefit for the specific procedure that was performed. This denial targets the anesthesia charge specifically — not the underlying surgical or diagnostic procedure. The payer's coverage guidelines either exclude anesthesia entirely for this procedure type, limit the anesthesia modality covered, or cap the number of anesthesia units allowed.

The 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF) often contains additional context for why the anesthesia was denied. This segment may reference a specific payer policy, LCD, or NCD that defines when anesthesia is and is not covered for the procedure in question. Reviewing this segment before taking action is critical because it tells you whether the denial is based on a blanket coverage exclusion or a specific clinical criterion that can be addressed through documentation.

Anesthesia providers, surgical centers, and hospital outpatient departments encounter CARC 269 when billing for anesthesia services on procedures that payers consider minor enough to be performed without anesthesia, or when the type of anesthesia used (e.g., general vs. local) exceeds what the payer covers. Under CO, the anesthesia charge is a contractual write-off. Under PR, the patient is responsible for the anesthesia cost. In both cases, if the anesthesia was medically necessary due to the patient's condition (e.g., anxiety disorder, physical disability, pediatric patient), an appeal with clinical documentation can be effective.

Common Causes

How to Resolve

Review the 835 policy segment for the specific denial reason, verify anesthesia coding accuracy, and appeal with medical necessity documentation if the anesthesia was clinically required.

1. Review the payer's anesthesia coverage policy Identify whether the procedure is categorically excluded from anesthesia coverage or whether specific documentation could qualify it for coverage.
2. Verify coding and crosswalk accuracy Confirm the anesthesia code maps correctly to the surgical procedure and that all required modifiers are present.
3. Appeal with medical necessity if applicable If the patient's condition required anesthesia beyond the payer's standard guidelines, submit an appeal with the anesthesiologist's notes, patient history, and clinical rationale.
4. Post the write-off if the denial is valid If the procedure does not qualify for anesthesia coverage and no medical necessity exception applies, write off the contractual adjustment.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-269:

How to Prevent CO-269

• Verify anesthesia coverage for the specific procedure with the payer before administering anesthesia services
• Obtain prior authorization for anesthesia when the payer requires it or when coverage is uncertain
• Document medical necessity for anesthesia in the patient's chart, especially for procedures not typically requiring it
• Maintain a reference of payer-specific anesthesia coverage policies and procedure exclusions

General Prevention

• Verify anesthesia coverage eligibility for the specific procedure before administering anesthesia services
• Obtain prior authorization for anesthesia when the payer requires it for the planned procedure
• Document medical necessity clearly in patient records, especially when anesthesia is requested for procedures where it is not typically covered
• Maintain effective communication between the surgical team, anesthesia providers, and billing staff regarding coverage limitations
• Monitor payer policy updates on anesthesia coverage requirements
• Ensure accurate anesthesia coding including correct CPT codes, modifiers, and time units

Also Filed As

The same CARC 269 may appear with different Group Codes:

Related Denial Codes