91Denial Code (CARC)Active
CO 91 Denial Code - Fix Dispensing Fee Adjustments
Code 91 indicates that the dispensing fee was adjusted on the claim. The payer has altered the amount reimbursed for the dispensing fee, which is separate from the medication cost itself.
Who Pays: Group Code Liability
For code 91, the adjustment typically falls under CO (Contractual Obligation), meaning the provider writes off the difference and cannot bill the patient for it.
Why Claims Get Code 91
- The payer's contract specifies a lower dispensing fee than was billed.
- The claim included a dispensing fee not covered under the payer's policy.
- The dispensing fee was incorrectly coded or calculated on the claim.
- The payer has a standard dispensing fee that differs from what was billed.
- The dispensing fee exceeds the payer's allowable limit.
How to Fix & Resubmit
- Review the payer contract to verify the allowed dispensing fee.
- Confirm the dispensing fee was coded correctly on the claim.
- Check if the payer has specific rules or limits for dispensing fees.
- If an error was found, adjust the claim to reflect the correct dispensing fee.
- Resubmit the corrected claim if necessary.
Corrected Claim or Appeal?
Submit a corrected claim when the dispensing fee was erroneously billed or coded. If the adjustment aligns with the payer's contract, an appeal is not warranted.
Preventing Future 91 Denials
- Ensure dispensing fees are entered according to the payer's contracted rates.
- Regularly update billing systems with current payer fee schedules.
- Train staff on payer-specific dispensing fee policies to avoid errors.
- Implement a verification step for dispensing fees before claim submission.