CO-170 denials (Medicare)


Albany, GA
Best answers
Anyone else having issues with claims denying with CO-170? We have several NPPs that have always ordered labs and mammograms and are now having their claims (randomly) deny with CO-170 and I can't find anything anywhere stating they aren't able to order these tests. We have called (numerous times) and of course they don't seem to really know what is going on either-they even told us at one point it was a system error and they were working on getting it fixed. So frustrating. Thanks, Kimberly
Is this a facility or Drs. office? Also, what are the codes used on the claim form. Labs and mammograms codes? Do you have a referring physician on the claim?
We are a Dr.'s office. Several CPT codes but two of the most common being denied are 87800 and 77067. Yes we have a referring physician on the claim.
OK, so CO-170 means: This payment is adjusted when performed/billed by this type of provider. The CO represents "contract issue" meaning that there may be something in your contract, with that specific insurance company, that is not allowing the NPPs to bill for these services. Contracts are updated by some insurance companies quarterly and/or yearly. That would be my first step in this process and maybe see when the last time a NPP was paid for these services?

Do you have any other denial codes on these codes like an M or N denial reason. Usually these denials help tell the "denial" story a little better.
I hope this was helpful and if you have any more questions dont hesitate to ask. :)