Documentation does not support this level of service
The payer reviewed the records (or applied an edit) and believes the visit or service billed is a higher level than the documentation supports. It may pay a lower level instead.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- E/M level higher than the medical decision making or time documented.
- Records sent on request did not include the full note, orders or time statement.
- Payer prepayment review of a provider who bills high levels more often than peers.
The fix
Have a certified coder review the note against the current E/M guidelines. If the level is supported, appeal with the full record and a short explanation of the decision making or time. If it is not, accept the lower level and give the provider coding feedback.
Appeal or corrected claim?
Appeal with records when supported. Do not send a corrected claim with a different level unless the original was a coding error.
Deadline to watch
Medicare redetermination 120 days; commercial 60 to 180 days per contract.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-150 in short
What does CO-150 mean?
The payer reviewed the records (or applied an edit) and believes the visit or service billed is a higher level than the documentation supports. It may pay a lower level instead. The official X12 text reads: "Payer deems the information submitted does not support this level of service."
What usually causes a CO-150 denial?
E/M level higher than the medical decision making or time documented. Records sent on request did not include the full note, orders or time statement. Payer prepayment review of a provider who bills high levels more often than peers.
How do I fix CO-150?
Have a certified coder review the note against the current E/M guidelines. If the level is supported, appeal with the full record and a short explanation of the decision making or time. If it is not, accept the lower level and give the provider coding feedback.
Should I appeal CO-150 or send a corrected claim?
Appeal. Appeal with records when supported. Do not send a corrected claim with a different level unless the original was a coding error.
What deadline applies to CO-150?
Medicare redetermination 120 days; commercial 60 to 180 days per contract.