DENIAL CODE · CO-197

CO-197: Precertification / Authorization Absent

CO-197 means the payer says the required prior authorization, precertification, or notification wasn't obtained before the service. It's one of the most common denials — and a large share are recoverable.

Official (X12/WPC): "Precertification/authorization/notification/pre-treatment absent."

Why payers issue CO-197

Authorization was required and not obtained, or obtained for the wrong code
It was an emergent or add-on service where auth wasn't practical
The auth existed but wasn't linked to the claim correctly
The payer's own record of the auth is wrong

Is it recoverable? Often recoverable via retroactive authorization, proof the service was emergent, or by tying an existing auth to the claim. Not a dead end.

How to appeal a Prior Authorization denial →

Common questions

What does CO-197 mean?

How do I appeal or fix a CO-197 denial?

Often recoverable via retroactive authorization, proof the service was emergent, or by tying an existing auth to the claim. Not a dead end. Common causes: authorization was required and not obtained, or obtained for the wrong code; it was an emergent or add-on service where auth wasn't practical; the auth existed but wasn't linked to the claim correctly; the payer's own record of the auth is wrong.

Is a CO-197 denial worth appealing?

Often recoverable via retroactive authorization, proof the service was emergent, or by tying an existing auth to the claim. Not a dead end. You only pay on what's actually recovered, so there's no cost to working the ones that are winnable.

Other denial codes

CO-50 · Not Medically Necessary →CO-16 · Missing or Invalid Information →CO-45 · Charge Exceeds Fee Schedule →CO-97 · Bundled into Another Service →CO-29 · Timely Filing Expired →CO-96 · Non-Covered Charge →OA-18 · Duplicate Claim →OA-22 · Coordination of Benefits →CO-11 · Diagnosis Inconsistent with Procedure →CO-151 · Too Many Services (Frequency/MUE) →CO-B7 · Provider Not Eligible →CO-27 · Coverage Terminated →CO-204 · Not Covered Under Current Plan →CO-109 · Not Covered by This Payer →CO-119 · Benefit Maximum Reached →CO-4 · Modifier Inconsistent or Missing →CO-15 · Authorization Number Missing or Invalid →OA-23 · Prior Payer Adjudication Impact →CO-24 · Charges Covered Under Capitation →CO-26 · Expenses Incurred Prior to Coverage →CO-54 · Assistant Surgeon Not Covered →CO-55 · Experimental / Investigational →CO-58 · Inappropriate Place of Service →CO-59 · Multiple/Concurrent Procedure Reduction →CO-107 · Related/Qualifying Claim Not Identified →CO-167 · Diagnosis Not Covered →CO-170 · Denied for This Provider Type →CO-181 · Procedure Code Invalid on Date of Service →CO-182 · Procedure Modifier Invalid on Date of Service →CO-183 · Referring Provider Not Eligible to Refer →CO-185 · Rendering Provider Not Eligible →CO-198 · Precertification / Authorization Exceeded →CO-226 · Requested Provider Information Not Provided →CO-231 · Mutually Exclusive Procedures →CO-234 · Procedure Not Paid Separately →CO-236 · Procedure/Modifier Combination Not Compatible →CO-242 · Out-of-Network / Non-Network Provider →CO-252 · Documentation Required to Adjudicate →CO-253 · Sequestration Reduction →CO-256 · Not Payable Per Managed-Care Contract →CO-288 · Referral Absent →CO-B15 · Qualifying Service Not Received →CO-B16 · New Patient Qualifications Not Met →CO-A1 · Claim/Service Denied (Remark Required) →

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