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CARC
CO-167
CARC
CO — Contractual Obligation
Coding/Modifier
Quick Facts
Code
CO-167
Type
CARC
Category
Coding/Modifier
Status
Active
This diagnosis is not covered — missing/incomplete/invalid diagnosis
What Does This Code Mean?
The diagnosis code submitted is not covered for the billed service, or is missing/invalid.
Common Causes
- ICD-10 code doesn't match payer coverage policy for the CPT
- Diagnosis code truncated or invalid for date of service
- Diagnosis pointer on claim doesn't align with documentation
Recommended Next Steps
- Cross-check ICD-10 code validity for the date of service
- Confirm the diagnosis supports medical necessity per payer policy
- Correct and resubmit as a corrected claim
- Query the provider if documentation doesn't support a covered diagnosis
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Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.