Claim adjustment reason code
Denial code CO-167 meaning
CARC 167, usually seen as CO-167: The plan does not cover the diagnosis or diagnoses on the claim.
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- Reason code
- CARC 167
- Short name
- Diagnosis not covered
- Plain meaning
- The plan does not cover the diagnosis or diagnoses on the claim.
- Group codes
- CO-167: Contractual obligation. The provider absorbs the amount under its contract or the payer's rules. Do not bill the patient for it.
Plain-English summary written by Rivvi. X12 owns the CARC list and its exact wording, which is not reproduced here. Read it on the X12 CARC list (list dated November 1, 2025, checked October 23, 2026). This page does not decide how a claim is paid.
Common causes
- The diagnosis is excluded from the plan, or is not on the coverage policy for the service.
What to check before resubmitting
- Check that the right diagnosis is coded and pointed to.
- Check the payer's coverage policy, or the LCD or NCD for Medicare.
Remark codes that often come with it
Related reason codes
Related pages
Questions
What does denial code CO-167 mean?
The plan does not cover the diagnosis or diagnoses on the claim. This is Rivvi's plain-English summary of CARC 167. X12's exact wording is on x12.org.
How do I fix CO-167?
Check that the right diagnosis is coded and pointed to. Check the payer's coverage policy, or the LCD or NCD for Medicare.
Can I bill the patient for CO-167?
With group code CO, no. CO means the provider absorbs the amount under its contract or the payer's rules.
Which group codes come with CARC 167?
Most often CO (contractual obligation). The group code, not the reason code, says who owes the amount.
What is the difference between a CARC and a RARC?
A claim adjustment reason code (CARC) says why a claim line was paid differently than billed. A remittance advice remark code (RARC) adds detail, such as which field is missing.