Denial Code CO-152: Not Deemed Medical Necessity - No Prior Auth
What Does Code 152 Mean?
Payer deems the information submitted does not support the level of service for this date of service. Prior authorization was not obtained.
Group Code CO (Contractual Obligation): The provider has agreed to accept the payer's determination. The patient is generally not responsible for this amount.
Why Does This Happen?
Service rendered without obtaining required prior authorization, and the payer deems it not medically necessary.
How to Resolve It
- 1Attempt retroactive authorization with clinical documentation
- 2Schedule a peer-to-peer review to discuss medical necessity
- 3File appeal with complete clinical records
This Denial Is Often Overturned With a Peer-to-Peer Call
When you receive denial code CO-152, the most effective next step is usually a peer-to-peer (P2P) call with the payer's medical director. During this call, you can present your clinical reasoning directly and often get the denial reversed on the spot.
Our free P2P Call Prep Tool generates a structured script based on your specific case, the payer involved, and the denial reason -- so you walk into the call prepared and confident.
Want the full strategy?
The P2P Playbook covers payer-specific approaches for denial code CO-152 -- plus 15 denial objections with word-for-word responses, what reviewers are actually thinking, and the 60-second prep framework. Written by a medical director who reviewed cases for major payers.
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