835 Denial Combination
CO-49
Contractual Obligation · Service-Line Level Adjustment
What This Combination Means
The service is non-covered because it does not meet the definition of a medical/dental service or is considered a convenience item.
N/A
Appeal Success
14-30 days
Avg. Resolution
Hard
Difficulty
No
Appealable
Step-by-Step Resolution
Steps tailored specifically to this CO-49 combination — not generic advice.
- 1
Review the payer's definition of a covered service against the billed procedure.
- 2
If the service can be re-classified under a covered CPT/HCPCS code with proper documentation, resubmit.
- 3
Inform the patient of the non-covered determination and their financial responsibility.
- 4
Bill at your standard self-pay rate for truly non-covered services.
Specialty Context
How CO-49 typically presents across different practice types.
Dental
Verify the service is non-covered because it does not meet the definition of a medical/dental service or is considered a convenience item per your dental plan contract and documentation requirements.
Medical
Confirm the service is non-covered because it does not meet the definition of a medical/dental service or is considered a convenience item against payer policy and submit corrected claim as needed.
Behavioral Health
Apply behavioral health parity rules and confirm the service is non-covered because it does not meet the definition of a medical/dental service or is considered a convenience item per MHPAEA standards.
Individual Code References
View the standalone definition for each code in this combination.
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