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4
CO - Contractual ObligationCoding/Billing

Denial Code CO-4: Procedure Code Inconsistent with Modifier

What Does Code 4 Mean?

The procedure code is inconsistent with the modifier used, or a required modifier is missing.

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?

Incorrect modifier appended to the CPT code, or a modifier was not included when required.

How to Resolve It

  1. 1Review CPT and modifier coding guidelines
  2. 2Correct the modifier and resubmit
  3. 3Verify with the payer which modifier is expected

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