CARC 287 Active

CO-287: Referral Exceeded

TL;DR

You exceeded the referral limit. Get a new referral or extension from the referring physician and resubmit. If retroactive referral is not available, appeal with medical necessity documentation.

Action

Verify & Resubmit

Who Pays

Provider

Appeal

Yes

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-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 post as a contractual adjustment. 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

Cause	Frequency
Number of visits exceeds referral authorization The number of visits or services provided surpassed the authorized limit on the referral from the primary care provider	Most Common
Referral expired before all services were rendered The referral had a validity period that expired before all planned services could be completed	Common
Services exceed scope of referral authorization The services rendered go beyond what was authorized in the original referral, including additional procedures or service types	Common
Failure to obtain referral renewal The provider did not obtain a renewed or extended referral when the original authorization was used up	Common

How to Resolve

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

Appeal Guide

Obtain an updated referral from the referring physician if possible. File an appeal with the updated referral, medical records documenting the necessity for additional visits, and a letter from the treating provider explaining why the referral limit was insufficient for the patient's condition.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-287:

RARC	Description
N362	Alert: The number of services or units exceeds our acceptable maximum. Verify the referral authorization limits and obtain an extension if additional visits are medically necessary →
N381	Alert: Consult your contractual agreement for restrictions, billing, and payment information. Review referral requirements in the plan contract →

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

Track referral utilization to know when patients are approaching their authorized visit limits
Request referral renewals or extensions before the authorized visits are exhausted
Implement referral management software for real-time tracking of authorization limits
Communicate with referring providers proactively when additional services may be needed
Train staff on referral tracking procedures and authorization renewal processes

Also Filed As

The same CARC 287 may appear with different Group Codes:

PR-287 OA-287

Related Denial Codes

CO-116 — Advance Indemnification Notice Requirements Not Met CO-119 — Benefit Maximum Reached CO-222 — Exceeds Contracted Maximum Hours/Days/Units CO-273 — Coverage/Program Guidelines Were Exceeded CO-39 — Services Denied at Authorization/Pre-certification

Sources

https://www.mdclarity.com/denial-code/287
https://resdac.org/sites/datadocumentation.resdac.org/files/Adjustment%20Reason%20Code%20Code%20Table%20(TAF%20Claims).txt
https://x12.org/codes/claim-adjustment-reason-codes
Codes maintained by X12. Visit x12.org for official definitions.