264Denial Code (CARC)Active
CO 264 Denial Code - Understanding & Resolving
Code 264 indicates an adjustment made for postage costs specifically related to pharmaceuticals. On your remittance, this means the payer has deducted an amount for postage expenses associated with mailing prescriptions or related pharmaceutical items.
Who Pays: Group Code Liability
Adjustments under code 264 typically fall under the CO group code, meaning it is a contractual obligation and the provider must write off the amount; the patient should not be billed for this adjustment.
Why Claims Get Code 264
- The payer deducted postage costs for shipping pharmaceuticals.
- Pharmacy-related claim includes a line item for postage costs that the payer does not cover.
- Contract terms include a provision for deducting postage costs from reimbursements.
How to Fix & Resubmit
- Verify the contract terms with the payer to ensure postage cost adjustments are accurate.
- Check the claim details to confirm if postage was incorrectly added as a line item.
- Review the remittance advice to ensure the adjustment aligns with the payer's policy.
- If the adjustment was made in error, contact the payer for clarification or dispute the adjustment if necessary.
Corrected Claim or Appeal?
Typically, code 264 adjustments are legitimate under contract terms and do not require corrections or appeals. However, if an error is suspected, contact the payer.
Preventing Future 264 Denials
- Review contracts to understand postage cost terms before submitting claims.
- Ensure postage costs are not included in claims unless contractually covered.
- Communicate with payers to clarify their policies on postage adjustments.
- Educate billing staff on identifying and managing expected postage adjustments.