Denial Codes for Behavioral Health
Common insurance claim denial reason codes encountered in behavioral health billing, with guidance on appeals and corrections.
CO-109 Denial Code: Not Covered by This Payer | Scriber
CO-109 denial — claim not covered by this payer or plan. Coverage verification, carve-outs, and how to appeal benefit exclusions.
CO-119 Denial Code: Benefit Maximum Reached | Scriber
CO-119 denial — benefit maximum for this period has been reached. How session limits work, appeal options, and planning for annual caps.
CO-150 Denial Code: Information Doesn't Support Level of Service | Scriber
CO-150 denial — payer says documentation doesn't justify treatment intensity. Medical necessity review, level-of-care appropriateness, and appeals.
CO-151 Denial Code: Payment Adjusted for Modifier Requirements | Scriber
CO-151 denial — payment adjusted because of payer's modifier requirements. Required modifiers, what they mean, and how to prevent adjustments.
CO-16 Denial Code: Lacks Information Needed | Scriber
CO-16 denial — claim lacks information needed for adjudication. What it means, why it happens in behavioral health, how to fix and prevent it.
CO-167 Denial Code: Diagnosis Code Not Covered | Scriber
CO-167 denial — claim denied because diagnosis code(s) aren't covered. Covered diagnosis restrictions, behavioral health parity, and how to appeal.
CO-181 Denial Code: Procedure Code Invalid for Date of Service | Scriber
CO-181 denial — the procedure code used is not valid (active/approved) on the date the service was provided. CPT code activation, updates, and how to fix this.
CO-187 Denial Code: Consumer-Directed Plan Billing Requirements | Scriber
CO-187 denial — service billed does not comply with consumer-directed health plan (CDHP) or Health Savings Account (HSA) plan requirements. CDHP rules and billing strategies.
CO-190 Denial Code: Patient Eligibility Criteria Not Met | Scriber
CO-190 denial — patient does not meet the plan's eligibility criteria for this service. Age restrictions, enrollment status, provider network, and eligibility verification.
CO-197 Denial Code: Precertification/Authorization Absent | Scriber
CO-197 — precertification or authorization absent. Understand what this denial means, why it happens, how to respond, and how to prevent it.
CO-204 Denial Code: Service Not Paid Under PPS | Scriber
CO-204 — service not paid under Prospective Payment System. Understand when this denial applies, what it means for your billing, and how to respond.
CO-22 Denial Code: Care May Be Covered by Another Payer | Scriber
CO-22 denial — care may be covered by another payer per coordination of benefits. How COB works, why mental health claims are affected, and how to resolve.
CO-227 Denial Code: Information Requested From Provider Not Provided | Scriber
CO-227 — information requested from billing or rendering provider not provided. Understand what payers request, how to respond, and how to prevent future denials.
CO-231 Denial Code: Mutually Exclusive Procedures Cannot Be Done Same Day | Scriber
CO-231 — mutually exclusive procedures cannot be done in same day. Understand which codes conflict, when you can bill them together, and how to prevent this denial.
CO-29 Denial Code: Time Limit for Filing Has Expired | Scriber
CO-29 denial — claim filed after the payer's deadline. Timely filing requirements, behavioral health deadlines, and how to appeal out-of-time claims.
CO-45 Denial Code: Charge Exceeds Fee Schedule Maximum | Scriber
CO-45 denial — charge billed exceeds the payer's fee schedule maximum. Reconciling billed vs. allowed amounts, fee schedules, and appeal strategies.
CO-50 Denial Code: Non-Covered Service Not Medically Necessary | Scriber
CO-50 denial — service not covered because not deemed medically necessary. Medical necessity standards, behavioral health review, and how to appeal.
CO-97 Denial Code: Payment Included in Another Service | Scriber
CO-97 denial — service payment is bundled or included in another service. RVU bundling, unbundling rules, and how to appeal included services.
PR-1 Denial Code: Deductible Amount | Scriber
PR-1 — deductible amount. Understand patient deductibles, when to collect, how to verify coverage, and manage this patient responsibility.
PR-2 Denial Code: Coinsurance Amount | Scriber
PR-2 — coinsurance amount. Understand patient coinsurance, calculate what patients owe, verify coverage, and manage collections.
PR-22 Denial Code: This Care May Be Covered By Another Payer | Scriber
PR-22 — this care may be covered by another payer. Understand coordination of benefits, subrogation, and how to handle this patient responsibility code.
PR-26 Denial Code: Expenses Incurred Prior to Coverage | Scriber
PR-26 — expenses incurred prior to coverage. Understand coverage effective dates, eligibility gaps, and how to handle claims outside the benefit period.
PR-27 Denial Code: Expenses Incurred After Coverage Terminated | Scriber
PR-27 — expenses incurred after coverage terminated. Understand coverage termination dates, continuation options, and how to handle post-termination claims.
PR-3 Denial Code: Co-payment Amount | Scriber
PR-3 — co-payment amount. Understand patient copays, when they apply, how to collect, and best practices for managing patient cost-sharing.
PR-45 Denial Code: Charge Exceeds Fee Schedule for Patient's Plan | Scriber
PR-45 denial — charge billed exceeds the specific patient's plan fee schedule maximum. Patient-plan-specific fee schedules and billing reconciliation.
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