CO-58Contractual Adjustment
Treatment not authorized by plan
What this code means
This specific treatment was not authorized by your plan. Different from a prior authorization issue -- this means the treatment itself falls outside covered benefits.
What to do next
Review your plan documents to confirm whether this treatment is excluded. If you believe it should be covered, appeal with clinical documentation and reference any applicable state mandates that may require coverage.
Appeal outlook: Moderate depending on plan type and state
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