CO-288 fires when a plan requires a referral from the primary care physician and none is recorded for the visit. The requirement is a plan-design condition rather than a clinical judgement, and the cure is usually documentary.
What CO-288 means
On plans that require referrals, the primary physician must record one with the payer, not merely direct the patient. The two frequent failures are a referral documented in the primary's chart but never submitted, and one submitted for a different number of visits, a different specialty or a lapsed period. Both are curable if the primary physician acts, which is why the specialist's appeal usually starts with a phone call rather than a letter.
Why CO-288 fires
- The primary physician directed the patient without recording a referral with the payer.
- The referral covered a different specialty, provider or visit count.
- The referral had expired by the date of service.
- The plan requires referrals and the patient self-referred.
Is CO-288 worth appealing?
Often worth appealing
How to resolve or appeal CO-288
- 1
Confirm with the referring practice
Whether a referral was recorded, for what specialty, period and visit count.
- 2
Request a retroactive referral
Many plans permit one within a window; that is the cleanest resolution.
- 3
Document the direction to care
Where no retroactive referral is possible, the primary's note directing the patient supports the appeal.
CO-288 — frequently asked
Can the patient be billed?
Do referrals expire?
Reason-code meanings are paraphrased from the X12 Claim Adjustment Reason Code list for plain-language reference; they are not reproduced verbatim. This is general information, not legal, coding, or medical advice — always confirm against the payer's remittance and policy.
Turn this CO-288 denial into a signed appeal
Upload the denied EOB and Merits builds a complete CO-288 appeal — the argument, the payer's own coverage criteria, and your federal appeal rights, every claim cited to a named source. $9 a letter. No account.