Denial Code 256: What It Means and What to Do
If you are looking up code 256, here is what it means and what to do next. This is usually a patient-cost or contractual amount, but if it looks wrong, we can help you check.
Denial code 256 means: The service is not payable under the terms of the managed care contract between the provider and the plan.
Why it happens: You typically see this when the billed service falls outside what the provider's contract with your managed care plan allows, which is usually a provider and payer contract matter rather than a patient charge.
Is it appealable? This code reflects a patient-cost or contractual amount, not a denial you appeal directly. If you believe it was applied in error, the underlying claim can be reviewed.
What to send: the missing element for this code, a short appeal letter citing the plan's claims-procedure rules, and any clinical support.
Note: code 256 may appear on your remittance with a group-code prefix such as PR-256 (patient responsibility) or CO-256 (contractual obligation). The denial reason is the same.
Think this was applied in error?
A senior reviewer can check your bill and the underlying claim for errors. $0 upfront, with no obligation.
Get help with code 256Frequently asked questions
- What does denial code 256 mean?
- The service is not payable under the terms of the managed care contract between the provider and the plan.
- Is denial code 256 appealable?
- It is often not appealable directly, but the underlying claim may be.
- What should I send to appeal a code 256 denial?
- Supply the missing element for this code, a short appeal letter citing the plan's claims-procedure rules, and any clinical support. Apellica prepares and files this for you.