CO-50: Non-Covered Service
CO (Contractual Obligation)What is CO-50?
CO-50 is a Contractual Obligation code indicating the service billed is not covered under the patient's benefit plan. This denial means the payer determined the service falls outside the plan's covered services, either by policy exclusion or because prior authorization was not obtained.
Why Does CO-50 Occur?
- Service excluded from the patient's benefit plan. The procedure is specifically listed as non-covered in the plan documents.
- Prior authorization not obtained. The service requires pre-approval, and none was on file when the claim was submitted.
- Experimental or investigational classification. The payer considers the procedure experimental and does not cover it under the plan.
- Plan limitation reached. The patient has exceeded the plan's limit for this type of service (e.g., maximum PT visits per year).
How to Fix CO-50 Denials
- Review the EOB to determine why the service was classified as non-covered. The RARC code will specify the reason.
- Check the patient's benefit plan for coverage of the specific CPT code. If the service is covered, submit a corrected claim with supporting documentation.
- If prior authorization was required but missing, obtain a retroactive authorization if the payer allows it, then resubmit.
- If the payer classifies the service as experimental, appeal with peer-reviewed clinical evidence and a letter of medical necessity from the provider.
CO-50 by Payer
| Payer | Common RARC | Appeal Deadline | Notes |
|---|---|---|---|
| UnitedHealthcare | N/A | 60 days from remittance | Check UHC's medical policy bulletins for coverage criteria. |
| Anthem | N/A | 365 days from denial notice | Anthem publishes clinical guidelines per state. Verify coverage before billing. |
| Aetna | N/A | 180 days from denial | Aetna allows retroactive auth requests within 72 hours for urgent services. |
| Cigna | N/A | 180 days from denial | Review Cigna's coverage policies for the specific CPT code. |
| Medicare | N/A | 120 days (redetermination at MAC) | Check NCD/LCD databases for Medicare coverage of the procedure. |
Related CARC Codes
If you are seeing CO-50, check these related codes: CO-11 (diagnosis inconsistent with procedure), CO-197 (precertification absent), CO-167 (diagnosis not covered).
Common Questions About CO-50
Is CO-50 always a final denial?
No. CO-50 can often be overturned if the service is actually covered but was denied due to missing authorization, incorrect coding, or a payer processing error. Check the specific reason before accepting the denial.
Can I bill the patient for a CO-50 denial?
It depends. If the patient signed an ABN (Advance Beneficiary Notice) for Medicare or a financial responsibility waiver for commercial plans, you may bill the patient. Without a signed waiver, the provider typically absorbs the cost.
Altair catches CO-50 denials before submission with coverage verification before submission. See how pre-submit claim scoring works.