CO 170: Provider Type Not Covered
This payer does not pay this service when this type of provider performs it.
Check whether the service qualified as incident-to, or should have been billed under a supervising provider the payer recognises.
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- No patient data
- No BAA
- No charge
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What CO 170 means
CO: Contractual obligation. The provider absorbs it and cannot bill the patient.
So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
Is It Worth Appealing?
Usually recoverable. Appeal it. The money is usually there.
Why It Fires
In the order we see it.
The rendering provider type is not eligible for this service under the payer's policy.
The service met incident-to requirements but was billed directly.
How to Appeal CO 170, Step by Step
Check whether the service qualified as incident-to, or should have been billed under a supervising provider the payer recognises.
- 1Step 1: Read the remark code. Find the remark code printed next to CO 170 on the 835 or EOB. It says what the payer wants back.
- 2Step 2: Find the cause. Match the denial to one of the 2 causes in Why It Fires above, and fix that one.
- 3Step 3: Take the first action. Check whether the service qualified as incident-to, or should have been billed under a supervising provider the payer recognises.
- 4Step 4: Attach the documentation. Documentation supporting incident-to billing, where the requirements were genuinely met on the day.
- 5Step 5: Send the appeal before the deadline. Send it to the payer with the claim, the denial and the documentation, inside the payer's appeal window. See what an appeal letter must contain and the filing limits by payer.
The common mistake. Do not rebill under a supervising provider unless the incident-to requirements were actually met. That is a compliance exposure, not a workaround.
Free: the Denial Code Appeal Playbook. 53 codes on one sheet: appeal, fix and resubmit, or let it go, and what to attach. Get the playbook
CO 170 description
This payer does not pay this service when this type of provider performs it.
This payer does not pay this service when this type of provider performs it. So the balance cannot move to the patient. Either the appeal recovers it or the practice absorbs it. That makes the appeal decision the whole decision on this line.
This is our plain-English wording, not the official X12 text. X12 asserts copyright over the published descriptions, so we write our own and say what it means for the money rather than restating the code.
Where this comes from. This is our own reading of the code, not the payer's and not a copy of the standards text. We classify it from how these denials actually resolve. Where we are unsure, we say so rather than guessing.
Related Codes
CO 185
The rendering provider is not eligible to perform the service billed.
Read the CO 185 pageCO 242
The provider was out of network, or not the patient's assigned primary care provider.
Read the CO 242 pageCO 27
Coverage had ended on the date of service.
Read the CO 27 pageCO 26
Service fell before coverage started.
Read the CO 26 page
Your Questions Answered
What does CO 170 mean?
This payer does not pay this service when this type of provider performs it. Contractual obligation. The provider absorbs it and cannot bill the patient.
Can you appeal CO 170?
Usually recoverable. Check whether the service qualified as incident-to, or should have been billed under a supervising provider the payer recognises.
Why does CO 170 happen?
The rendering provider type is not eligible for this service under the payer's policy. The service met incident-to requirements but was billed directly.
What documentation wins a CO 170 appeal?
Documentation supporting incident-to billing, where the requirements were genuinely met on the day.
How do I appeal a CO 170 denial?
Step 1: Read the remark code. Find the remark code printed next to CO 170 on the 835 or EOB. It says what the payer wants back. Step 2: Find the cause. Match the denial to one cause: The rendering provider type is not eligible for this service under the payer's policy. The service met incident-to requirements but was billed directly. Step 3: Take the first action. Check whether the service qualified as incident-to, or should have been billed under a supervising provider the payer recognises. Step 4: Attach the documentation. Documentation supporting incident-to billing, where the requirements were genuinely met on the day. Step 5: Send the appeal before the deadline. Send it to the payer with the claim, the denial and the documentation, inside the payer's appeal window.
Most searched: CO 97 · CO 96 · OA 23 · PR 204 · CO 109 · CO 197 · CO 45 · CO 50
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