Denial Code CO50 means in Medical Billing is “Non-covered services because this is not deemed a ‘medical necessity’ by the payer.” Means as per insurance, provided services patient are not medically necessary for.
CO 50 denial is an common reason and frequent denial, there are some specific reasons for getting denial code CO-50 mentioned below,
- Lack of supporting documents or medical records.
- Incorrect ICD code which are not related to patient procedures.
- Some times, services provided to patient not covered by insurance.
- Sometimes insurance found service provided not proven like experimental services.
- Some services needs pre-authorization which not obtained.
How to handle CO 50 Denial in Medical Billing?
CO 50 Denial is a frequent denial and we have to follow below mentioned steps to handle this denial or avoid ,
Step 1-
We need to check first EOB, in EOB denial reason was updated with explanation, so we have to found the exact reason for Medical Necessity denial.
Step 2-
Check If claim denied due to diagnosis, recheck all ICD codes with coding team. Diagnosis codes should append as per service provides. If any extra Dx code append, need to submit documents of that service for support and justify the service.
Step 3-
Sometime CO 50 denial received due to lack of Medical records, so need to send complete medical records with reconsideration letter. Need to call insurance and take full detail of mailing address and fax number for send medical records.
Step 4-
Review Local Coverage Determination in case of Medicare insurance. Review Local Coverage Determinations (LCDs), LCD policy, and documentation. It will help that the services being billed meet Medicare’s coverage and guidelines. Documentation with these policies can strong your appeal and increase chance of claim approval.
Conclusion:
CO 50 Denial code is a medical necessity related denial so most of the time need to resubmit claim with proper medical records. We need to recheck ICD and CPT codes before 1st time claim submission.
All these steps avoid denial code CO-50 medical necessity.