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49
CO - Contractual ObligationCoverage
Denial Code CO-49: Non-covered: Routine/Screening
What Does Code 49 Mean?
This is a non-covered service because it is a routine/preventive/screening procedure or service not covered under the patient's benefit plan.
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?
Preventive services not covered, or the claim was coded as routine when it should reflect a diagnostic indication.
How to Resolve It
- 1Review if a diagnostic ICD-10 code should replace the screening code
- 2Verify the patient's preventive benefits
- 3Resubmit with appropriate diagnosis if clinically warranted
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