EOB denial code CO-167: what it means

What it means

The diagnosis on the claim is not a covered condition under your plan for this service.

Contractual Obligation — an adjustment the provider agreed to by contract. The patient is generally not billed for CO amounts.

Official X12 description

“This (these) diagnosis(es) is (are) not covered”

Typical cause

The plan does not cover treatment for this diagnosis, or a more appropriate diagnosis code may apply.

What to do next

1. 1Confirm the diagnosis code submitted was correct and complete.
2. 2Check your plan documents for whether this condition is excluded.
3. 3If the diagnosis was wrong, request a corrected claim; if it was right, consider an appeal.