CO-14: Procedure Not Payable as Billed
CO (Contractual Obligation)What is CO-14?
CO-14 is a Contractual Obligation code indicating the submitted procedure is not separately payable as billed. This typically means the payer considers the service incidental to the primary procedure, or the billing format does not meet submission requirements.
Why Does CO-14 Occur?
- Service is incidental to the primary procedure and not separately billable.
- Incorrect billing format (e.g., professional claim for a service that requires institutional billing).
- Revenue code mismatch on institutional claims.
- Procedure requires additional documentation or a specific claim format the payer did not receive.
How to Fix CO-14 Denials
- Review the payer's billing guidelines for the specific CPT code and claim type.
- If the service is incidental, it cannot be billed separately. Adjust the claim.
- If the billing format is wrong (CMS-1500 vs. UB-04), resubmit on the correct form.
- Appeal with documentation if the service is separately billable and the payer's adjudication is incorrect.
CO-14 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | Varies | 60 days from remittance | Reconsideration required before formal appeal. |
| Anthem | Varies | 365 days from denial notice | Check state-specific provider manual for variations. |
| Aetna | Varies | 180 days from denial | Strict in-network filing enforcement. |
| Cigna | Varies | 180 days from denial | Cigna COB team: 1-800-244-6224. |
| Medicare | Varies | 120 days (redetermination at MAC) | Five levels of appeal starting with MAC redetermination. |
Related CARC Codes
If you are seeing CO-14, check these related codes: CO-16 (claim differs), CO-45 (fee schedule), CO-29 (timely filing).
Common Questions About CO-14
What does CO-14 mean?
CO-14 indicates procedure not payable as billed. Check the RARC code on the EOB for the specific reason and follow the resolution steps above.
Can I appeal a CO-14 denial?
Yes. Commercial payers allow 60-365 days to appeal depending on the payer. Gather supporting documentation before filing. Medicare allows 120 days for a redetermination request.
Altair catches CO-14 denials before submission with claim format validation. See how pre-submit claim scoring works.