How do I resolve a CO-198+N133 denial?

Identify the specific procedure code and authorized unit count from the prior authorization. Determine the exact units billed on the denied service line. If additional units were clinically necessary: request an authorization amendment for the additional units with supporting clinical documentation. If the additional units were billed in error: void the claim and resubmit with the correct unit count (equal to or less than authorized). If the authorization does not specify units (unusual), appeal citing the payer's own auth documentation and request clarification on unit limits.

Can I appeal a CO-198+N133 denial?

Yes. CO-198+N133 denials are typically appealable with a 58% success rate. Resolution difficulty is Medium and typically takes 14-21 days.

835 Denial Combination

CO-198+N133

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

Units billed exceed the authorized amount, and N133 specifies: the number of units billed exceeds the number authorized for this procedure. Similar to CO-198-NONE but with a specific remark clarifying it's a unit count issue rather than a visit/service type mismatch.

58%

Appeal Success

14-21 days

Avg. Resolution

Medium

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-198+N133 combination — not generic advice.

1
Identify the specific procedure code and authorized unit count from the prior authorization.
2
Determine the exact units billed on the denied service line.
3
If additional units were clinically necessary: request an authorization amendment for the additional units with supporting clinical documentation.
4
If the additional units were billed in error: void the claim and resubmit with the correct unit count (equal to or less than authorized).
5
If the authorization does not specify units (unusual), appeal citing the payer's own auth documentation and request clarification on unit limits.

Specialty Context

How CO-198+N133 typically presents across different practice types.

Dental

Dental procedure codes billed per tooth or per surface can exceed auth limits if multiple teeth are treated in a session. Confirm the auth specifies the tooth numbers and surfaces authorized.

Medical

Common for HCPCS codes billed per unit (e.g., drugs billed per dose, supplies billed per unit of measure). The authorized dose/quantity must match the billed amount.

Behavioral Health

Group therapy billed per session may have unit limits. A 90-minute group session billed as 2 units must have 2 units authorized.

Individual Code References

View the standalone definition for each code in this combination.

CARC 198 RARC N133

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