Who has to pay after a code 112 denial?

Usually the provider's problem — not yours. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.

How long do I have to appeal?

It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.

All denial codes · code 112

Denial code 112: what it means — and how to fight it

Denial code 112 (shown on your EOB as CO-112 or PR-112) means: “Service not furnished directly to the patient and/or not documented.” In plain English: The plan says there is no record that this service was actually delivered to you in person.

medium appealability Usually the provider's problem — not yours

What they're really saying

“Service not furnished directly to the patient and/or not documented.”

The plan says there is no record that this service was actually delivered to you in person.

Your odds

Worth fighting — many of these get fixed.

Usually resolved when the chart notes for that date are submitted.

Fewer than 1 in 100 denied claims are ever appealed. When people do appeal, roughly 4 in 10 win the first round — and independent external review overturns 40–50% of what reaches it.

How to appeal a code 112 denial

Decode. You just did — this page is step one.
Set your clock. 180 days for most employer and marketplace plans, 120 for Original Medicare, ~90 for Medicaid, only 65 for Medicare Advantage.
Urgent? If this is care you still need, call and request an expedited appeal — they must decide within 72 hours.
Ask the provider's office to send the plan the chart notes for that visit. Ask the provider to send the visit notes and any signed forms for that date of service. If it was a phone or video visit, ask that the telehealth modifier and platform be documented. Request your own copy of the record so you can confirm the date and service match what you remember.
Send it certified. Letter plus evidence, keep copies of everything.
Escalate. Denied again? Independent external review — a doctor who doesn't work for your insurer decides.

Do it in minutes, free

The AppealClock tool translates your denial, drafts your appeal letter, computes your exact deadline — and watches the clock so you don't have to. No account. Your medical details never leave your device.

Start your appeal & set your clock →

Common questions

What does denial code 112 mean?: The plan says there is no record that this service was actually delivered to you in person.
Can I appeal a CO-112 or PR-112 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are medium: Usually resolved when the chart notes for that date are submitted. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 112 denial?: Usually the provider's problem — not yours. The letters in front of the number matter: CO (contractual obligation) usually means an in-network provider must absorb it, while PR (patient responsibility) means the plan says you owe it.
How long do I have to appeal?: It depends on your coverage: 180 days for most employer and marketplace plans, 120 days for Original Medicare, about 90 days for Medicaid (varies by state), and only 65 days for Medicare Advantage. Set your deadline clock before you do anything else.