DENIAL CODE · CO-198

CO-198: Precertification / Authorization Exceeded

CO-198 means an authorization existed but the services billed went beyond what it allowed — more visits, units, or a longer date range than the auth covered.

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

Why payers issue CO-198

  • Services exceeded the units or visits the auth authorized
  • The date of service fell outside the auth's approved window
  • Additional medically necessary care wasn't added to the auth
  • The auth covered a narrower scope than what was rendered

Is it recoverable? Recoverable by requesting an amended or extended authorization, or documenting the medical necessity for the services beyond the original auth.

How to appeal a Prior Authorization denial →

Common questions

What does CO-198 mean?

CO-198 means an authorization existed but the services billed went beyond what it allowed — more visits, units, or a longer date range than the auth covered. Precertification/notification/authorization/pre-treatment exceeded.

How do I appeal or fix a CO-198 denial?

Recoverable by requesting an amended or extended authorization, or documenting the medical necessity for the services beyond the original auth. Common causes: services exceeded the units or visits the auth authorized; the date of service fell outside the auth's approved window; additional medically necessary care wasn't added to the auth; the auth covered a narrower scope than what was rendered.

Is a CO-198 denial worth appealing?

Recoverable by requesting an amended or extended authorization, or documenting the medical necessity for the services beyond the original auth. You only pay on what's actually recovered, so there's no cost to working the ones that are winnable.

Other denial codes
CO-197 · Precertification / Authorization Absent →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-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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