CO-24 Denial Code: Covered by a Capitation Agreement or Managed Care Plan
The CO-24 denial code means the charges are covered under a capitation agreement or managed care plan - the payer you billed is saying the service is already paid for through a different arrangement. In Medicare billing this most often means the patient is enrolled in a Medicare Advantage plan, so the claim must go to that plan instead of traditional Medicare.
Common Causes
- The patient is enrolled in a Medicare Advantage plan but the claim was sent to traditional (fee-for-service) Medicare
- The provider participates in a capitated arrangement where this service is included in the per-member payment, so no separate fee-for-service payment is due
- Eligibility was not checked at the visit, so the Medicare Advantage or managed care enrollment was missed
- The patient switched plans during open enrollment and registration still lists the old coverage
How to Fix CO-24
- Run eligibility for the date of service and identify the patient's actual plan - for Medicare patients, check for Medicare Advantage enrollment
- Rebill the claim to the correct managed care plan with that plan's payer ID and member number
- If you are capitated for this patient, confirm whether the service is inside the capitation agreement - if it is, there is no additional payment to pursue
- If the service is carved out of the capitation agreement, bill per the carve-out terms with any required documentation
- Fix the front-end eligibility workflow so plan enrollment is verified at every visit, especially in the first quarter after open enrollment
Frequently Asked Questions
CO-24 means the charge is covered under a capitation agreement or a managed care plan. For Medicare claims it usually means the patient is enrolled in a Medicare Advantage plan and the claim went to traditional Medicare by mistake.
Verify eligibility for the date of service, identify the managed care plan the patient is actually enrolled in, and rebill that plan. If you hold a capitation contract covering the service, there is no separate payment to collect - the capitation payment already covers it.
No. CO-24 is a contractual obligation adjustment. The correct move is billing the right plan, not the patient.
Related Denial Codes
Related Resources
Claim adjustment reason codes and remittance advice remark codes are standardized code sets maintained by X12. The explanations on this page are written in our own words for educational purposes, based on public CMS and Medicare contractor documentation. Payer policies vary - always confirm handling with the specific payer's guidance and your contracts.