CO-198 denial code
An authorization exists, but the service went beyond it: more days, units, or visits, or dates past the approved span.
“Precertification/notification/authorization/pre-treatment exceeded.”
Start 10/31/2006 · Last modified 05/01/2018 · X12 adjustment reason code list
What it usually means in behavioral health
CO-198 is the concurrent-review denial. A residential or PHP stay continues past the last approved day while the next review is pending, or after a partial approval nobody reflected in the schedule.
Outpatient and ABA programs hit it when sessions or units run past the authorized count before reauthorization comes through.
Common causes
- Days billed after the last approved date while a concurrent review was still pending
- A partial approval (fewer days or units than requested) not reflected in scheduling
- Authorization expired and renewal was not requested before the end date
- Units per session or per week above the authorized frequency, common in ABA and IOP
- A single claim spanning dates past the authorization end date
Correct and resubmit, or appeal?
If an extension or new authorization was approved, correct the claim: split the dates or reference the right authorization. If the extra days were denied in concurrent review, the real fight is an appeal of that review decision, with the clinical record for those days. The claim denial follows from it.
What to do
Match billed dates and units against every authorization and extension on file.
Split the claim if some dates fall under a later authorization.
For days denied in concurrent review, appeal the review decision and track its deadline separately from the claim.
Set alerts ahead of authorization end dates, and request renewals before they lapse.
Often seen with
- N54
- N362
- N640
Got a CO-198 on your desk?
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