CMS 2026 Alert: Quarterly ICD-10-CM & NCCI updates active.
About Us Editorial Policy Contact RCM Team
🔍 Quick Search
CO-56 - Denial Journal
CARC CO — Contractual Obligation

CO-56

Procedure/treatment not deemed 'proven to be effective' by the payer

What This Code Means

Similar to CO-55 — the payer doesn’t consider this treatment to have established clinical effectiveness.

Common Causes

  • Treatment falls outside payer's evidence-based coverage criteria
  • Insufficient clinical documentation of expected outcomes

How to Resolve or Appeal

  1. Review the payer's specific medical policy criteria
  2. Appeal with supporting clinical literature if there's a reasonable case

Related Codes

CO-55

More Denial Codes to Check

RARC MA50 RARC M25 Information furnished does not substantiate the need for this level of service CARC CO-150 Payer deems the information submitted does not support this level of service CARC CO-261 The procedure or service is inconsistent with the patient's history CARC CO-154 Payer deems the information submitted does not support this day's supply CARC CO-D2 RARC M26 CARC CO-151 Payer deems the information submitted doesn't support this many/frequency of services CARC CO-50 Non-covered because not deemed a medical necessity by the payer CARC CO-152 Payer deems the information submitted does not support this length of service

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

🏠 Home 🔍 Lookup 📋 Appeals 📖 Guides
Scroll to Top