Denial codes / CO-167
Denial code 167CO-167: Diagnosis not covered
Diagnosis is not covered.
What to doFix and resend
Often recoverableYes, when worked
The letters in front matter. CO means the office can't bill the patient for the amount; PR means the patient may owe it. The same number can appear with either, so read both parts.
Why dental offices see it
- The diagnosis code on the claim is not covered for this service.
- A diagnosis code was required and missing or wrong.
What to do
- Check the diagnosis code.
- Correct it if it was wrong and resend; otherwise appeal with records.
Stop it next time
Add diagnosis codes when a plan or Medicaid program requires them.
How many CO-167 claims are in your report? The free check counts them, ranks them by dollars and deadline and drafts the letter. It runs in your browser; nothing is uploaded.
Plain-English paraphrase; the official code list is maintained by X12. Insurer rules vary; check the insurer's provider manual. Not legal advice.