CO-49 means the plan does not cover the routine or preventive exam or screening you billed. With the CO group you cannot bill the patient unless they signed a valid waiver, such as a Medicare ABN, before the service.
The official wording
The X12 Claim Adjustment Reason Code list defines 49 as: "This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam."
The letters in front are the group code. CO means contractual obligation (the provider absorbs it), PR means patient responsibility, and OA is other adjustment. The same reason code can come with different group codes, so always read both.
What CO-49 is telling you
Many plans cover preventive care, but not every routine service, and some cover only one preventive visit a year. Traditional Medicare does not pay for a routine physical exam. It does pay for the Welcome to Medicare preventive visit and the yearly wellness visit, which are different services with their own codes.
If the patient also had a real problem treated at the same visit, the problem part can often be billed as a separate E/M service with modifier 25, as long as the note supports it.
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Common causes
- A routine physical (for example CPT 99381 to 99397) billed to a plan that does not cover it, including traditional Medicare.
- A preventive visit billed more often than the plan allows.
- A screening test billed on the same day as a non-covered routine exam.
- A wrong diagnosis code that makes a problem visit look routine.
How to fix it
- Check the patient's benefits for preventive visits and frequency.
- If it was really a problem visit, correct the codes and send a corrected claim.
- For Medicare, consider whether the Welcome to Medicare visit or the annual wellness visit should have been billed instead.
- Bill the patient only if they signed a valid ABN (Medicare) or the plan's waiver before the service, and the claim shows it, for example with modifier GA for Medicare.
How to prevent it
- Check preventive benefits and the date of the last preventive visit before scheduling.
- Use a signed ABN for Medicare patients who want a routine physical.
- Train providers to document a separate problem clearly when they treat one at a preventive visit.
Questions people ask about CO-49
Does Medicare cover a routine physical?
No. Traditional Medicare covers the Welcome to Medicare preventive visit and a yearly wellness visit, but not a routine physical exam.
Can I bill the patient for CO-49?
Only if the patient signed a valid waiver, such as a Medicare ABN, before the service. Otherwise it is the provider's write-off.
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PR-1 · PR-2 · PR-3 · CO-4 · CO-5 · CO-11 · CO-15 · CO-16 · OA-18 · CO-22 · OA-23 · CO-24 · CO-26 · CO-27 · CO-29 · CO-31 · CO-45 · CO-49 · CO-50 · CO-59 · PR-96 · CO-97 · CO-109 · CO-119 · CO-129 · CO-140 · CO-146 · CO-151 · CO-167 · CO-170 · CO-181 · CO-185 · CO-197 · CO-198 · PR-204 · CO-234 · CO-236 · CO-242 · CO-252 · CO-253 · CO-288 · CO-A1 · CO-B7 · MA130 · N130 · N23 · N290
Timely filing limits by payer: Cigna timely filing limit · HealthSpring timely filing limit · Aetna timely filing limit · UnitedHealthcare timely filing limit · Humana timely filing limit · corrected claim timely filing limits
Sources: X12 Claim Adjustment Reason Code list (49), read October 26, 2026; CMS Medicare guidance where Medicare rules are mentioned. Last reviewed October 26, 2026. General information, not coding or legal advice. Payer rules differ, so check the remark code and the payer's own policy.