CO-167: Diagnosis not covered
UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE
The payer says your plan doesn't cover treatment for this diagnosis. Check both directions: whether the diagnosis code was right, and whether the exclusion is real.
CO-167 at a glance
- Code group: CO — Contractual Obligation — in-network providers generally cannot bill you for CO adjustments.
- Who usually fixes it: You (the member).
- Worth appealing? Yes — commonly appealed.
What to do about a CO-167 denial
- Verify with the provider that the diagnosis code on the claim is accurate.
- Ask the insurer to cite the exact plan exclusion.
- Appeal if the diagnosis was miscoded or the plan language doesn't actually exclude it.
Best next read: How to appeal, step by step — the full guide (with a free letter template) for this denial type.
Denied? Don’t drop it
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