What does denial code CO-167 mean?

Diagnosis is not covered. The diagnosis on the claim is not covered by the plan for this service.

How do I fix a CO-167 denial?

Review the coding against the documentation. Correct if wrong; otherwise bill per the patient's benefits.

Pricing

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Claim adjustment reason code · Contractual obligation

CO-167
Diagnosis is not covered

What CO-167 means

The diagnosis on the claim is not covered by the plan for this service.

The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.

Common causes

Diagnosis excluded under the plan
Wrong or non-specific diagnosis code

How to fix it

Review the coding against the documentation
Correct if wrong; otherwise bill per the patient's benefits

Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.

Prevent it next time

Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.

Other codes

All denial codes →

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CO-167Diagnosis is not covered