How do I resolve a CO-241 denial?

Confirm the authorization requirement by checking the patient's Summary of Benefits and Coverage (SBC) and the payer's prior auth list. Determine if retroactive authorization is possible — contact the payer's authorization department directly. Prepare clinical documentation supporting the medical necessity of the service. If retroactive auth is denied, file a formal appeal with supporting clinical notes and the treating provider's letter of medical necessity. For future patients, add this procedure to your pre-authorization checklist to prevent recurring denials.

Can I appeal a CO-241 denial?

Yes. CO-241 denials are typically appealable with a 48% success rate. Resolution difficulty is Hard and typically takes 21-45 days.

835 Denial Combination

CO-241

Contractual Obligation · Claim-Level Adjustment

What This Combination Means

No authorization was obtained for this service. The member's benefit plan requires prior authorization for the billed service and none was submitted. This is distinct from CO-197 in that CO-241 is used by payers for certain categories of services (often specialty care or high-cost procedures) where the auth requirement is benefit-design-level, not just a utilization management requirement.

48%

Appeal Success

21-45 days

Avg. Resolution

Hard

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-241 combination — not generic advice.

1
Confirm the authorization requirement by checking the patient's Summary of Benefits and Coverage (SBC) and the payer's prior auth list.
2
Determine if retroactive authorization is possible — contact the payer's authorization department directly.
3
Prepare clinical documentation supporting the medical necessity of the service.
4
If retroactive auth is denied, file a formal appeal with supporting clinical notes and the treating provider's letter of medical necessity.
5
For future patients, add this procedure to your pre-authorization checklist to prevent recurring denials.

Specialty Context

How CO-241 typically presents across different practice types.

Dental

Used by some payers for implant-supported prosthetics or orthodontic services where auth is a plan-level benefit requirement.

Medical

Common for specialty drugs (biologics, specialty injectables) administered in an office setting, and for durable medical equipment.

Behavioral Health

May appear for intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) that require auth from the MBHO.

Individual Code References

View the standalone definition for each code in this combination.

CARC 241

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