Who has to pay after a code 268 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 268

Denial code 268: what it means — and how to fight it

Denial code 268 (shown on your EOB as CO-268 or PR-268) means: “The Claim spans two calendar years. Please resubmit one claim per calendar year.” In plain English: Your care crossed New Year's Day, so the plan wants it split into two claims. Watch your deductible when that happens.

medium appealability Usually the provider's problem — not yours

What they're really saying

“The Claim spans two calendar years. Please resubmit one claim per calendar year.”

Your care crossed New Year's Day, so the plan wants it split into two claims. Watch your deductible when that happens.

Your odds

Worth fighting — many of these get fixed.

A billing fix — but it can legitimately cost you a second deductible.

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 268 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 to split the claim at the year end and rebill both halves. The provider needs to split the claim at December 31 and rebill both halves. The real risk to you is your deductible and out-of-pocket maximum resetting on January 1, so check which days landed in which year and whether the split was done correctly. For an inpatient stay, many plans apply a single cost share based on the admission date — ask whether that rule applies before you pay two deductibles.
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 268 mean?: Your care crossed New Year's Day, so the plan wants it split into two claims. Watch your deductible when that happens.
Can I appeal a CO-268 or PR-268 denial?: Yes. Appealing is free and it is your legal right. For this code the odds are medium: A billing fix — but it can legitimately cost you a second deductible. Fewer than 1 in 100 denials are ever appealed — insurers count on silence.
Who has to pay after a code 268 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.