CO 198: Authorization Exceeded
Authorised, but more units or visits were billed than approved.
Appeal for the extra units with the treatment notes, or request a retro-extension.
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What CO 198 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.
More units or visits were billed than the authorisation approved.
A second episode of care was billed under the first episode's authorisation.
How to Appeal CO 198, Step by Step
Appeal for the extra units with the treatment notes, or request a retro-extension.
- 1Step 1: Read the remark code. Find the remark code printed next to CO 198 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. Appeal for the extra units with the treatment notes, or request a retro-extension.
- 4Step 4: Attach the documentation. Treatment notes showing medical necessity for the units beyond the approval. A re-authorisation request covering the additional units.
- 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 write off the whole claim. Usually only the excess above the approved units was denied, and the rest paid.
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 198 description
Authorised, but more units or visits were billed than approved.
Authorised, but more units or visits were billed than approved. 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.
Your Questions Answered
What does CO 198 mean?
Authorised, but more units or visits were billed than approved. Contractual obligation. The provider absorbs it and cannot bill the patient.
Can you appeal CO 198?
Usually recoverable. Appeal for the extra units with the treatment notes, or request a retro-extension.
Why does CO 198 happen?
More units or visits were billed than the authorisation approved. A second episode of care was billed under the first episode's authorisation.
What documentation wins a CO 198 appeal?
Treatment notes showing medical necessity for the units beyond the approval. A re-authorisation request covering the additional units.
How do I appeal a CO 198 denial?
Step 1: Read the remark code. Find the remark code printed next to CO 198 on the 835 or EOB. It says what the payer wants back. Step 2: Find the cause. Match the denial to one cause: More units or visits were billed than the authorisation approved. A second episode of care was billed under the first episode's authorisation. Step 3: Take the first action. Appeal for the extra units with the treatment notes, or request a retro-extension. Step 4: Attach the documentation. Treatment notes showing medical necessity for the units beyond the approval. A re-authorisation request covering the additional units. 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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