CO-289: Dental/Medical Plan Benefits Not Available

What Does CO-289 Mean?

When CARC 289 appears with CO, the provider must absorb the cost of the denied services. The payer has determined that under contractual terms, the service is excluded from both dental and medical plan benefits and the provider cannot transfer this balance to the patient. This typically occurs when the provider is contracted with the plan and the service falls outside the covered benefit categories.

When CARC 289 appears on your remittance, the payer is communicating that the services billed have been evaluated under both the dental and medical plan benefit structures, and coverage is not available under either one. This code sits at the intersection of dental-medical coordination and is often triggered when a procedure could theoretically fall under either benefit type but the patient's specific plan design excludes it from both.

This denial frequently surfaces with procedures that straddle the dental-medical boundary, such as certain oral surgery procedures, TMJ treatments, or dental anesthesia services. The payer has determined that the dental plan does not cover the service, and the medical plan also does not provide benefits for it. Unlike CARC 290 or 291 where the claim is forwarded to the other plan, CARC 289 indicates that both avenues have been exhausted.

The financial impact depends heavily on the group code. With CO, the provider absorbs the cost. With OA, the responsibility may fall on the patient or require further investigation. Before writing off the balance, verify that the correct procedure and diagnosis codes were used, as coding adjustments may allow the claim to be reprocessed successfully under one of the plans. Related codes to be aware of include CARC 254, 270, and 280, which address similar cross-plan coverage scenarios.

Common Causes

How to Resolve

Verify coding accuracy, confirm coverage exclusions under both plans, and either appeal with medical necessity documentation or inform the patient of their financial responsibility.

1. Confirm the contractual exclusion Review your contract with the payer to verify the service is indeed excluded. If you believe the contract should cover it, escalate to your payer representative.
2. Explore alternative coding Review whether a different procedure code or diagnosis code could shift the claim to a covered benefit category under either plan.
3. Write off if confirmed If the exclusion is valid, write off the balance as a contractual adjustment. Do not transfer the CO-289 amount to the patient.

How to Prevent CO-289

• Verify coverage for services that straddle dental and medical plans before rendering them
• Maintain current knowledge of plan exclusions for both dental and medical benefits
• Discuss potential non-covered services with patients and obtain financial consent before treatment

General Prevention

• Verify eligibility and benefits under both dental and medical plans before rendering services
• Obtain necessary pre-authorizations from both plans when required
• Document medical necessity thoroughly to support cross-plan coverage arguments
• Stay current with policy changes for both dental and medical plan coverage
• Train billing staff on proper coordination of benefits between dental and medical plans

Also Filed As

The same CARC 289 may appear with different Group Codes:

Related Denial Codes