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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 CARC CO-152 Payer deems the information submitted does not support this length of service CARC CO-D2 RARC M123 RARC M42 RARC N362 Number of days or units of service exceeds acceptable maximum RARC M26 CARC CO-153 Payer deems the information submitted does not support this dosage CARC CO-154 Payer deems the information submitted does not support this day's supply CARC CO-150 Payer deems the information submitted does not support this level of service CARC CO-55 Procedure/treatment/drug deemed experimental/investigational by the payer

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

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