CO-199 denial code
On a facility claim, the revenue code and the procedure code on the same line don't match under the payer's rules.
“Revenue code and Procedure code do not match.”
Start 10/31/2006 · X12 adjustment reason code list
What it usually means in behavioral health
Behavioral health facility claims pair a revenue code (for example, the 090X and 091X behavioral health treatment codes or the 100X residential accommodation codes) with the HCPCS or CPT code the payer's contract or billing manual requires.
Pairings differ by payer and change at contract renewal, which is when CO-199s tend to spike.
Common causes
- A revenue code paired with a HCPCS or CPT code the payer doesn't accept with it
- A per diem code from one payer's contract used on another payer's claim
- A contract renewal changed the required pairing and the billing system wasn't updated
Correct and resubmit, or appeal?
Correct and resubmit with the pairing in the payer's current contract or billing manual. Appeal only if the pairing you billed matches the payer's own published rules.
What to do
Look up the payer's required revenue-code and procedure-code pairing for the level of care.
Correct the line and resubmit.
Keep a per-payer pairing table in the billing system, and update it at every contract renewal.
Often seen with
- M51
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