CARC 241 Active

CO-241: Low Income Subsidy (LIS) Co-payment Amount

TL;DR

The contractual adjustment reflects the LIS subsidy. Accept the adjustment.

Action
Review & Decide
Who Pays
Provider
Appeal
No
Patient Impact
None
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does CO-241 Mean?

With CO, the adjustment represents the contractual difference between the standard co-payment and the LIS co-payment.

CARC 241 indicates the co-payment amount assigned to a Medicare Part D beneficiary who qualifies for the Low Income Subsidy (LIS), also known as Extra Help. LIS beneficiaries receive reduced cost-sharing on their prescription drugs — their co-payments are significantly lower than standard Part D co-payments, typically ranging from $0 to a few dollars per prescription.

This code is not a denial — it is an informational adjustment showing the small co-payment amount the patient owes. The LIS program is designed to help low-income Medicare beneficiaries afford their medications, and the co-payment amounts are set by CMS annually.

How to Resolve

  1. Accept the adjustment The LIS subsidy is a government program — accept the reduced payment.
Do Not Appeal This Code

Low Income Subsidy (LIS) Co-payment Amount recorded under CO is a contractual obligation — the provider absorbs this amount per the payer agreement. Without an error in how the contract was applied, appeals don't apply. Review the accompanying RARC codes for context and accept the adjustment when the contract terms were applied correctly.

How to Prevent CO-241

Also Filed As

The same CARC 241 may appear with different Group Codes:

PR-241 OA-241

Related Denial Codes

CO-3 — Co-payment Amount CO-85 — Patient Interest Adjustment CO-100 — Payment Made to Patient/Insured CO-101 — Predetermination: Anticipated Payment CO-105 — Tax Withholding Amount

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://portal.ct.gov/-/media/ohs/health-it-advisory-council/apcd-advisory-group/data-submission-guide-workgroup/meeting-materials/6-30-22/carc-codes_final.pdf
  3. https://www.aapc.com/resources/claim-adjustment-reason-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.