CO-160
What This Code Means
Injury/illness was the result of an activity that is a benefit exclusion.
Common Causes
- Service falls under a specific plan exclusion
- Benefit maximum or occurrence limit already reached
- Wrong plan or benefit category billed
How to Resolve or Appeal
- Confirm the specific exclusion or limit that applies with the payer
- Check for secondary coverage that may pick up the balance
- Bill the patient per financial policy if the exclusion is confirmed accurate
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.