CO-248: Coinsurance for Professional Service in Institutional Setting

What Does CO-248 Mean?

CARC 248 identifies the patient's coinsurance obligation for a professional service provided in an institutional setting and billed on an institutional claim under a Medicare bundled payment program (PPACA). This is the coinsurance counterpart to CARC 247, which handles the deductible portion.

Under Medicare bundled payment arrangements such as BPCI, a single payment covers the entire episode of care. The patient's standard coinsurance obligation — typically 20% under Medicare Part B — still applies to the professional service component. CARC 248 isolates this coinsurance amount so the provider can collect the correct patient responsibility.

This code appears exclusively in Medicare bundled payment contexts. The coinsurance percentage follows standard Medicare Part B rules unless the bundled payment arrangement specifies otherwise.

How to Resolve

Verify the coinsurance calculation and collect from the patient. Contact the Medicare contractor if the amount seems incorrect.

1. Verify the coinsurance rate Confirm the coinsurance percentage applied matches the patient's Medicare Part B coinsurance rate (typically 20%).
2. Confirm bundled payment episode Verify this claim is part of a Medicare bundled payment episode where CARC 248 applies.
3. Send the patient a statement Issue a patient statement for the coinsurance amount, explaining the charge relates to the professional service component of their bundled care episode.
4. Contact Medicare if amount appears incorrect If the coinsurance calculation does not match the expected percentage of the allowed amount, contact the MAC for clarification.

Also Filed As

The same CARC 248 may appear with different Group Codes:

Related Denial Codes