CO-287: Referral Exceeded

What Does CO-287 Mean?

CO-287 means the provider continued to render services after the referral limit was reached without obtaining a new referral or extension. The provider absorbs the cost and cannot bill the patient. The fix is to obtain a retroactive referral or appeal with medical necessity documentation.

CARC 287 fires when the number of visits or services provided under a referral exceeds the authorized limit. Every referral has boundaries — a maximum number of visits, a date range, or both. Once those limits are reached, any additional services under that referral will be denied.

This denial is common in managed care plans (HMOs and some PPOs) that require referrals from a primary care physician before patients can see specialists. The referral typically authorizes a specific number of visits (e.g., 6 physical therapy sessions) or is valid for a limited time period (e.g., 90 days). When the provider continues treating the patient beyond those limits without obtaining a new or extended referral, CARC 287 results.

The financial impact depends on the Group Code. Under CO, the provider should have tracked the referral and obtained an extension before the limit was reached — they absorb the cost. Under PR, the patient is responsible because they continued scheduling appointments after being informed the referral was exhausted, or they failed to obtain a new referral from their PCP as required by their plan.

Common Causes

How to Resolve

Obtain a new referral or extension from the referring physician, then resubmit the claim with updated referral information.

1. Verify the referral limit Confirm how many visits were authorized, how many were used, and which specific visits exceeded the limit.
2. Request a new or extended referral Contact the referring physician to obtain a new referral or extension covering the additional visits.
3. Resubmit with new referral Submit the claim with the updated referral number from the referring provider.
4. Appeal if no retroactive referral If a retroactive referral cannot be obtained, appeal with clinical documentation showing the continued treatment was medically necessary.

How to Prevent CO-287

• Implement referral tracking with alerts when approaching the visit limit
• Request new referrals or extensions before the current one is exhausted
• Verify referral status at every visit, not just the first appointment
• Communicate with referring providers early when additional visits are anticipated
• Train front desk staff to check referral status before scheduling appointments

General Prevention

• Implement referral tracking in your practice management system with alerts when approaching the visit limit
• Request new referrals or extensions before the current referral is exhausted
• Verify referral status at each visit, not just the initial appointment
• Communicate with the referring provider early when additional visits may be needed
• Train front desk and scheduling staff to check referral status before booking appointments
• Conduct regular audits of referral utilization to catch tracking errors

Also Filed As

The same CARC 287 may appear with different Group Codes:

Related Denial Codes