CO-167Contractual Adjustment
Diagnosis is not covered
What this code means
Your insurer does not cover services for this specific diagnosis under your plan. This may be an exclusion in your plan documents.
What to do next
Review your plan exclusions list. Check whether your state has a mandate requiring coverage for this diagnosis. If the diagnosis code is incorrect, ask your provider to correct and resubmit.
Appeal outlook: Low to moderate depending on diagnosis and state
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