Who has to pay after a code 249 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 249

Denial code 249: what it means — and how to fight it

Denial code 249 (shown on your EOB as CO-249 or PR-249) means: “This claim has been identified as a readmission.” In plain English: You went back into the hospital soon after your last stay, so the plan is treating both stays as one. Usually a hospital payment issue rather than your bill.

medium appealability Usually the provider's problem — not yours

What they're really saying

“This claim has been identified as a readmission.”

You went back into the hospital soon after your last stay, so the plan is treating both stays as one. Usually a hospital payment issue rather than your bill.

Your odds

Worth fighting — many of these get fixed.

Often overturned when the second admission was clinically unrelated.

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 249 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.
Check whether you were charged two deductibles for what they call one stay. The winning argument is that the readmission was unrelated to the first stay or was clinically unavoidable — a new diagnosis, a different body system, or a planned staged procedure. Ask for both discharge summaries and have the physician document the distinction. Watch for a second deductible or copay charged for what the plan is calling one stay: if it is one stay for payment purposes, it should be one cost share for you.
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 249 mean?: You went back into the hospital soon after your last stay, so the plan is treating both stays as one. Usually a hospital payment issue rather than your bill.
Can I appeal a CO-249 or PR-249 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are medium: Often overturned when the second admission was clinically unrelated. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 249 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.