CO-154: Information Does Not Support Day's Supply

What Does CO-154 Mean?

With CO (Contractual Obligation), the CARC 154 adjustment is the provider's responsibility. The payer denied or reduced payment because of the quantity dispensed exceeds the payer's maximum day's supply limit for the medication, such as billing a 90-day supply when the plan only covers 30-day supplies. The patient is not liable for this amount. If the denial is in error, the provider can correct and resubmit the claim or file an appeal with supporting documentation.

CARC 154 indicates information does not support day's supply. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the quantity dispensed exceeds the payer's maximum day's supply limit for the medication, such as billing a 90-day supply when the plan only covers 30-day supplies; The day's supply listed on the claim does not mathematically match the quantity dispensed and the prescribed dosing frequency; The claim was submitted before the previous day's supply should have been exhausted, suggesting duplicate or premature dispensing. The group code paired with CARC 154 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

Common Causes

How to Resolve

1. Review the remittance details Examine the CO-154 adjustment and any accompanying RARC codes to identify the specific reason for the denial.
2. Identify the root cause Determine which issue applies: day's supply exceeds payer's maximum allowed, day's supply calculation does not match quantity and dosing instructions, refill too soon based on prior day's supply, among others.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the information does not support day's supply problem.
4. Resubmit the corrected claim Submit the corrected claim following the payer's resubmission guidelines. Include any supporting documentation that addresses the denial reason.
5. Appeal if the original claim was correct Appeal with documentation from the prescribing provider explaining why the prescribed day's supply is medically necessary, including the dosing regimen, clinical rationale for the quantity, and any prior authorization approvals for extended supply.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-154:

How to Prevent CO-154

• Verify payer-specific day's supply limits before dispensing medications
• Ensure day's supply calculations accurately reflect the quantity dispensed and prescribed dosing frequency
• Implement pharmacy system checks that validate day's supply against quantity and dosing instructions before claim submission
• Check refill history before dispensing to ensure the previous supply has been exhausted
• Obtain prior authorization for day's supply quantities that exceed payer limits
• Stay current on state and federal regulations for controlled substance day's supply limits

Also Filed As

The same CARC 154 may appear with different Group Codes:

Related Denial Codes