OA-202: Non-Covered Personal Comfort or Convenience Services
The comfort item was flagged during coordination of benefits. Check if any payer covers the service.
What Does OA-202 Mean?
With OA (Other Adjustments), the comfort item classification was applied during coordination of benefits. Review whether any payer in the COB chain covers the service or whether it should be redirected to the patient.
CARC 202 indicates that the payer considers the billed service to be for the patient's personal comfort or convenience rather than medically necessary treatment. Common examples include television rental during a hospital stay, private room upgrades when a semi-private room was medically sufficient, guest meals, cosmetic procedures, and other amenities that are not required for the patient's medical care.
This code can also appear when documentation does not adequately distinguish a medically necessary service from a comfort item. For instance, a private room may be medically required for infection control purposes, but without proper documentation, the payer may classify it as a personal convenience.
Common Causes
| Cause | Frequency |
|---|---|
| Coordination of benefits adjustment for non-covered comfort services In multi-payer scenarios, non-covered comfort services are adjusted under OA when determining payer responsibility | Common |
How to Resolve
- Review COB details Determine which payer classified the service as a comfort item.
- Check other payers Verify whether any other payer in the COB chain covers comfort or convenience items.
- Appeal if medically necessary If the service was medically required, appeal with clinical documentation.
Appeal with clinical documentation if the service was medically necessary and was incorrectly classified as a comfort or convenience item in the coordination of benefits process.
How to Prevent OA-202
- Verify which payer, if any, covers comfort/convenience items before billing
- Document non-covered items separately from covered medical services
Also Filed As
The same CARC 202 may appear with different Group Codes:
Related Denial Codes
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://www.mdclarity.com/denial-code/202
- 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
- Codes maintained by X12. Visit x12.org for official definitions.