CO 50 denial code (Not deemed a medical necessity by the payer)

CO 50 denial code – Not medically necessary

CO 50 denial code This denial happens when the service billed is not necessary/recommended to the condition of the patient. Then the claim could get denied for Not medically necessary. let me give you a good example so that you can get clarity in this denial.

Example

Mr.Mike met with a minor fracture on his finger so he decided to meet Mr.David who is the ortho specialist. Mike got an appointment and got treatment for his minor fracture. Meanwhile, mike decided to go for the entire body scan and got his report, and reached home. Now the bill denied as CO 50 denial code – Non-covered services Not deemed a medical necessity by the payer.

why is that denied? Can you guess? Any answers?

Answer– Mikes’s policy covered the fracture on his finger. But, the Entire body scan is not medically necessary for mike. Because, when the injury is only on the fingers there is no need for a body scan. Consequently, Due to this insurance denied as CO 50 denial code-Non-covered services Not deemed a medical necessity by the payer.

Solutions for CO 50 denial code

For CO 50 denial code – Not medically necessary you can check these parameters for the resolution on the claim. The diagnosis code is the main reason for this denial.

  • Validate the diagnosis code billed on the claim form whether it is payable and billed as per the LCD/NCD guidelines.
  • If you come to know that diagnosis is not payable code then check for the valid code and rebill based on LCD/NCD guidelines as a corrected claim.
  •  Thirdly, the Diagnosis code submitted is valid, but the supporting documentation is not supporting. Then the claim with supporting medical records should be appealed.

These three parameters help you to analyze the denial. Once you get clarity reach the claims department and ask these questions mention below in the flow chart.

Questionnaire Flow chart for denial co-50

 

Co 50 denied code not medically necessary

Recommended Key tips

In short, There can be two main actions if the diagnosis is correct ask the rep to send the claim back for review. This is to say if the service necessary for the patient then the claim should be reprocessed. Secondly, if the diagnosis is not valid to be billed send claim to coding to bill corrected claim with valid code. However, some insurance companies deny sending the claim back to review. Consequently, in that case, you can appeal to them with supporting documents to substantiate the service billed.

Read more about→   Global Period or Days denial for global surgery CPT

Leave a Comment