How do I fix or resolve code 287?

Verify the referral details — number of visits authorized, date range, and visits already used — by contacting the PCP office or checking the payer portal. If the referral was exceeded due to additional medically necessary visits, request a new or extended referral from the PCP with clinical justification for the additional visits. If the referral was exceeded but the services were urgent or emergent, file an appeal with documentation of the clinical urgency and the medical necessity of the additional visits. If the referral was not actually exceeded (e.g., the payer's visit count is incorrect), provide the referral documentation and visit history to the payer and request a claim reconsideration. If the referral cannot be extended and the appeal is denied, determine whether the patient can be billed per the plan's provisions or whether the balance must be written off as a provider adjustment.

287Denial CodeGeneral Adjustment

Code 287

Problem Description

Referral exceeded

Root Cause

The referral was exceeded — the patient has used up the number of visits or services authorized under the referral from their primary care physician (PCP). This is common in HMO plans where a PCP referral is required for specialist visits, and the referral specifies a limited number of visits (e.g., 3 visits, 6 months). Once the authorized visits are exhausted, the payer denies subsequent claims with CO-287. This is an administrative denial, not a clinical one — the services may have been medically necessary, but the referral limit was reached.

Resolution Steps

1Verify the referral details — number of visits authorized, date range, and visits already used — by contacting the PCP office or checking the payer portal.
2If the referral was exceeded due to additional medically necessary visits, request a new or extended referral from the PCP with clinical justification for the additional visits.
3If the referral was exceeded but the services were urgent or emergent, file an appeal with documentation of the clinical urgency and the medical necessity of the additional visits.
4If the referral was not actually exceeded (e.g., the payer's visit count is incorrect), provide the referral documentation and visit history to the payer and request a claim reconsideration.
5If the referral cannot be extended and the appeal is denied, determine whether the patient can be billed per the plan's provisions or whether the balance must be written off as a provider adjustment.

EHR Documentation Note

Claim denied 287 — referral exceeded; verified referral visit limits, requested extended referral from PCP if medically necessary, or appealed with clinical documentation.

Preventative Action

Track referral visit counts in the practice management system and alert front-office staff when a patient is approaching the referral limit so a new referral can be obtained before the next visit.

Related Codes in General Adjustment

Deductible Amount

Coinsurance Amount

Co-payment Amount

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.