Who has to pay after a code 240 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 240

Denial code 240: what it means — and how to fight it

Denial code 240 (shown on your EOB as CO-240 or PR-240) means: “The diagnosis is inconsistent with the patient's birth weight.” In plain English: A newborn claim was flagged because the diagnosis and the recorded birth weight don't line up. Almost always a coding error to correct.

high appealability Usually the provider's problem — not yours

What they're really saying

“The diagnosis is inconsistent with the patient's birth weight.”

A newborn claim was flagged because the diagnosis and the recorded birth weight don't line up. Almost always a coding error to correct.

Your odds

Strong — this type of denial has real weaknesses.

Correcting the birth-weight or diagnosis code resolves most of these.

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 240 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 hospital to check the baby's birth-weight coding. Ask the hospital to verify the recorded birth weight and diagnosis codes against the chart and resubmit a corrected claim.
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 240 mean?: A newborn claim was flagged because the diagnosis and the recorded birth weight don't line up. Almost always a coding error to correct.
Can I appeal a CO-240 or PR-240 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are high: Correcting the birth-weight or diagnosis code resolves most of these. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 240 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.