CO-226 at a glance
CO-226 | |
|---|---|
Group code | CO, Contractual Obligation (X12) |
CARC 226 text (X12) | Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) |
In the X12 list since | September 21, 2008. Last modified July 1, 2013 |
What it means for a therapy practice | A records or information request from the payer went unanswered, arrived after the deadline, or didn't cover what was asked |
Who owes the balance | No one can bill the client. The practice either gets it paid or writes it off |
Usual fix | Locate the request, answer it completely, and resubmit through the payer's reopening or appeal route |
CO 226 denial code description, in plain words
CARC 226 covers three separate failures in one sentence: the information was never provided, it was provided after the deadline, or it was insufficient or incomplete. The remittance doesn't tell you which one happened. The remark code that X12 requires alongside it, plus the payer's original letter, usually do.
"Billing/Rendering Provider" matters too. The request may have gone to the group practice as the billing provider, or to the individual clinician as the rendering provider. In a group, a letter addressed to an associate therapist who has since left can sit unopened until the deadline passes.
A worked example: a records request that sat in a portal
An illustrative case from a fictional group practice. The payer reviews eight 60‑minute sessions (90837) for one client and posts a request in its provider portal for the treatment plan and the progress notes for those dates, with a 30‑day deadline. Nobody checks the portal's message center. On day 31 the payer closes the review and the eight lines come back CO‑226.
The billing lead finds the request, pulls the treatment plan and the eight notes, and sends them with a reconsideration form and the claim numbers. The second time, the notes carry start and stop times, the goals from the plan, and what changed in each session, so the reviewer has what it asked for.
How to fix CO-226
- Find the original request. Check mail, fax, the payer portal's message center and any letters addressed to the rendering clinician by name.
- Read the remark code and the letter together, and list every item asked for. An incomplete answer earns the same code as no answer.
- Pull only the records for the dates of service in question. Under HIPAA's minimum necessary standard, a disclosure to a payer for payment should be limited to what the request needs.
- Send them through the route the payer names for a closed claim: a reopening, a reconsideration or an appeal, with the claim numbers and the original request reference on the cover sheet.
- Diary a follow-up. If the payer's appeal window has passed, ask whether it will accept the records late before you write the balance off.
What to send when the request is for therapy records
A payer reviewing therapy claims is normally after the clinical record: the intake assessment, the treatment plan in effect and the progress notes for the dates under review. HHS guidance on the minimum necessary requirement says it applies to disclosures for payment, though not to disclosures to another provider for treatment. So send the requested dates, not the whole chart.
Keep separate process notes out of it unless the request specifically asks and the client has authorized it. If your progress notes are thin, a treatment plan template and a consistent progress notes template make the next request quicker to answer. Practices that want every note to already carry times, plan goals and progress can have Twofold draft them from the session.
CO-226 vs CO-252 and PR-227
Code | Stage | Who has to act |
|---|---|---|
CO-252 | The payer needs a document before it can decide | The provider, by sending the attachment |
CO-226 | The payer already asked, and the answer was missing, late or incomplete | The provider, by answering and asking for reconsideration |
PR-227 | The payer asked the patient, insured or responsible party | The client or subscriber |
The X12 text of CARC 226 includes "not provided timely"; the text of its patient‑side counterpart, CARC 227, doesn't. So a late answer from your office is enough for CO‑226 even if the records were complete. For the patient‑side version, see PR-227. For the attachment request that often comes first, see CO-252. Other provider‑side denials: CO-11 when the diagnosis doesn't fit the procedure, and CO-18 for a duplicate claim.
The session codes most often under review in therapy are on the 90837, 90791 and 90832 pages.
CPT is a registered trademark of the American Medical Association. CPT codes copyright 2026 American Medical Association. All rights reserved.
Checked against the X12 Claim Adjustment Reason Code list in October 2026. CARC 226 was last modified on July 1, 2013, and nothing about it changed this year.