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243
CO - Contractual ObligationAuthorization
Denial Code CO-243: Service Not Authorized - Second Opinion
What Does Code 243 Mean?
Services not authorized. A mandatory second surgical opinion was not obtained prior to the procedure.
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?
The plan requires a second surgical opinion that was not obtained before the procedure.
How to Resolve It
- 1Check if a retroactive second opinion can be obtained
- 2Provide documentation of medical urgency if applicable
- 3Appeal with clinical justification
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