OA-264: Pharmaceutical Postage Cost Adjustment
Postage adjustment is an other adjustment. Check if a secondary payer should cover the charge.
What Does OA-264 Mean?
OA-264 indicates the postage cost adjustment does not fit standard contractual or patient responsibility categories, often appearing in coordination of benefits situations. The postage charge may need to be forwarded to a secondary payer for consideration.
CARC 264 signals that the payer has adjusted the postage cost portion of a pharmaceutical claim. This code is exclusively for pharmaceutical billing and covers the postal charges incurred when mailing medications to patients — typically through USPS or similar postal services. It is distinct from delivery (CARC 262), shipping via carrier (CARC 263), and administrative handling (CARC 265).
Pharmacies that mail prescriptions to patients, particularly mail-order pharmacies and specialty pharmacies serving patients in remote areas, are the primary recipients of this adjustment. The payer may deny postage charges entirely if the contract bundles all fulfillment costs into the drug reimbursement, or may allow postage up to a capped amount. In some cases, the denial occurs simply because the postage charge was not properly coded or documented on the claim.
Most CARC 264 adjustments appear with Group Code CO, making the postage cost a contractual write-off that the provider must absorb. The patient cannot be billed for this adjustment. Before accepting it, check whether your contract includes postage as a separately reimbursable line item and whether the correct billing codes were used. If postage is contractually covered and the payer denied it in error, request reprocessing.
Common Causes
| Cause | Frequency |
|---|---|
| Postage charges not a covered benefit The patient's plan does not reimburse postage costs for pharmaceutical mailings, so the payer adjusts the amount to zero | Most Common |
| Billing errors in postage charges Incorrect billing codes, wrong postage amounts, or quantity discrepancies on the claim | Common |
| Missing documentation for postage costs Insufficient supporting evidence such as postage receipts, mailing records, or prescription shipping logs | Common |
| Postage cost exceeds plan limits The billed postage amount exceeds the payer's maximum allowable charge for pharmaceutical mailing | Occasional |
| Medication not on formulary The pharmaceutical being mailed is not covered by the plan, so all associated costs including postage are denied | Occasional |
How to Resolve
Confirm postage cost coverage under your payer contract, verify billing accuracy, and resubmit with documentation or accept the contractual write-off.
- Check for secondary payer Determine if a secondary insurance plan may cover pharmaceutical postage costs.
- Forward to secondary payer if applicable Submit the claim to the secondary payer with the primary remittance attached.
How to Prevent OA-264
- Collect all insurance coverage details at intake for proper payer sequencing
- Automate routing of OA adjustments to secondary payer submission workflows
General Prevention
- Verify that pharmaceutical postage costs are a covered benefit under each payer contract before billing
- Maintain detailed postage documentation including receipts, mailing logs, and tracking information
- Ensure postage charges are properly separated from drug costs and use correct billing codes
- Conduct regular audits of pharmaceutical postage billing for accuracy
- Train staff on payer-specific requirements for postage cost reimbursement
Also Filed As
The same CARC 264 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/264
- https://x12.org/codes/claim-adjustment-reason-codes
- Codes maintained by X12. Visit x12.org for official definitions.