Denial Code CO 50

Denial Code CO 50 – Non covered services not deemed a medical necessity

When insurance company find the treatment rendered by provider is not medically necessary then they will indicate the claim with the denial code CO 50 – Non covered services not deemed a medical necessity.

For example: Consider provider billed the claim with Chest x ray with unrelated body part diagnosis.

In the above example insurance company will deny the claim as Procedure code billed with Diagnosis code is not compatible and its not necessary to be performed.

It is one of the complex denials and commonly seen in Medicare and Medicare advantage claims. If services billed are not covered as per LCD/NCD guidelines, then claim will be denied as services are not medically necessity and it’s denoted by denial code 50.

You require a good knowledge about medical coding guidelines and should be able to review the medical records in order to resolve the denial code CO 50 – Non covered services not deemed a medical necessity.

How to resolve Denial Code CO 50 – Non covered services not deemed a medical necessity?

• Whenever you receive the above denial code CO 50, then a very first step is to check the billing software whether same CPT and dx code billed previously is paid or not. If its paid then send the claim back for reprocessing.
• If not, then next step is to review the medical record to check why the test or procedure is performed.
• Check the diagnosis code billed and also to verify the diagnosis code submitted is compatible with procedure code billed under Medicare coverage database list (LCD/NCD guidelines list).
• You can search either by LCD/NCD number or search by CPT and your state with the following link. Usually you will find this LCD/NCD number on the denied EOB. Insurance will deny the claim as under this LCD/NCD number the claim is denied, so you can get LCD/NCD # on the denial EOB or you can reach insurance company department to find the LCD/NCD number.

MCD Search (cms.gov)

• If it’s not compatible and coding correction done as per coding team, then resubmit the claim as corrected claim.
• If you find the CPT code is billed with dx code is compatible, then call insurance company to reprocess the claim. If they disagree, then appeal the claim with medical records.

Note: if you are unable to review the medical records, then forward the claim to medical coding department for assistance.

Medical Billing Denials and actions – Top Denial codes Solutions (medicalbillingcycle.com)