How do I resolve a CO-197+N210 denial?

Correct claim and rebill with the 14-byte UTN provided within the affirmative decision letter If billing on CMS-1500 claim form, include UTN in Item 23 If billing electronically, include UTN in loop 2300 REF02 (REF01 = G1) or loop 2400 REF02 (REF01 = G1) If prior authorization is being bypassed, in certain situations, special modifiers are required to be appended to the claim. Please refer to Documentation and Modifier Requirements to Bypass Prior Authorization for those special modifiers If Advanced Beneficiary Notice of Noncoverage (ABN) was obtained because the beneficiary did not meet coverage criteria, or to bill a secondary insurance, and a non-affirmative prior authorization was obtained, submit a redetermination with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal

835 Denial Combination

CO-197+N210

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Prior authorization 14-byte Unique Tracking Number (UTN) was not appended to claim Special modifier to bypass the prior authorization process was not appended to claim line. This HCPCS code requires prior authorization

N/A

Appeal Success

7-14 days

Avg. Resolution

Medium

Difficulty

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-197+N210 combination — not generic advice.

1
Correct claim and rebill with the 14-byte UTN provided within the affirmative decision letter
2
If billing on CMS-1500 claim form, include UTN in Item 23
3
If billing electronically, include UTN in loop 2300 REF02 (REF01 = G1) or loop 2400 REF02 (REF01 = G1)
4
If prior authorization is being bypassed, in certain situations, special modifiers are required to be appended to the claim. Please refer to Documentation and Modifier Requirements to Bypass Prior Authorization for those special modifiers
5
If Advanced Beneficiary Notice of Noncoverage (ABN) was obtained because the beneficiary did not meet coverage criteria, or to bill a secondary insurance, and a non-affirmative prior authorization was obtained, submit a redetermination with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal

Specialty Context

How CO-197+N210 typically presents across different practice types.

Dental

Medical

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

CARC 197 RARC N210

Medicare Contractor Guidance for CARC 197

Noridian + uhc + aetna + bcbs_az

How to Prevent CARC 197 Denials

✓
Obtain prior authorization for item, prior to delivery
✓
Ensure to append 14-byte UTN provided within the affirmative decision letter to the claim
✓
If prior authorization is being bypassed, ensure the special modifiers required are appended to the claim line

Noridian Medicare Portal

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