CO-167 Denial Code
What it means
The insurer won't pay because the diagnosis on the claim isn't one it covers for this service.
Why it happens
A diagnosis (ICD-10) code was wrong, too vague, or genuinely outside coverage for the procedure.
What to do
Often a coding fix - confirm the correct diagnosis code with your provider and resubmit. If the diagnosis is right, appeal with medical records showing coverage applies.
Can you appeal it?
Yes; check for a coding error first.
Official description
This (these) diagnosis(es) is (are) not covered.
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