262Denial Code (CARC)Active
CO 262 Denial Code - Fix Delivery Cost Adjustments
Code 262 indicates that an adjustment has been made to a claim due to the delivery cost of pharmaceuticals. This adjustment specifically applies to claims involving medications, reflecting a reduction to account for the cost of delivering these pharmaceuticals.
Who Pays: Group Code Liability
For code 262, the adjustment is typically marked under the CO group code, meaning the provider must write off this amount and cannot bill the patient for it.
Why Claims Get Code 262
- The payer's contract includes terms that exclude delivery costs for pharmaceuticals.
- The submitted claim included a separate charge for delivery of medications, which the payer does not cover.
- An error in billing led to misinterpretation of delivery costs as part of the medication charge.
- The payer has a policy that disallows delivery fees for pharmaceuticals, resulting in the adjustment.
- A discrepancy in how the delivery cost was reported on the claim led to this adjustment.
How to Fix & Resubmit
- Review the payer contract to confirm if delivery costs for pharmaceuticals are excluded.
- Verify the claim to ensure that delivery costs were not incorrectly itemized or separated from medication charges.
- Check if there is any supporting documentation that justifies the delivery cost as part of the medication charge.
- If the delivery cost is indeed covered under certain conditions, contact the payer to discuss a possible reprocessing of the claim.
- If an error was found, correct the claim and resubmit it with accurate information.
Corrected Claim or Appeal?
For code 262, if the adjustment aligns with contractual terms, it should be accepted as a write-off. If you believe the adjustment is incorrect due to a billing error or misinterpretation, submit a corrected claim. Appeal if the payer's policy is unclear or if documentation supports coverage.
Preventing Future 262 Denials
- Ensure all pharmaceutical claims are reviewed for delivery cost inclusion before submission.
- Clarify with payers during contract negotiations whether delivery costs for pharmaceuticals are covered.
- Train billing staff to accurately distinguish between medication and delivery charges.
- Implement a checklist for claims including pharmaceuticals to verify compliance with payer policies.