CO 157 denial code
Claim adjustment reason code 157. Often reported as CO 157 or PR 157.
Service resulted from an act of war
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What 157 means
The service was needed because of an act of war, which the plan treats as an exclusion from coverage.
Many plans exclude care for injuries or illnesses caused by war. This code means the payer decided the service falls under that exclusion.
Coverage may lie with another source, such as a government program for service members or veterans. Check the claim's accident and injury details first, since a wrong code or indicator can trigger this.
Group codes seen with 157
On a remittance, 157 comes after a group code. These are the ones it is most often reported with:
- CO 157 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
- PR 157 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.
The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.
Common causes
- The injury or illness was caused by military action covered by the plan's war exclusion.
- Accident or injury details on the claim pointed the payer to the exclusion.
- Another government program is responsible for war-related care for this patient.
What to do next
- Confirm the cause of the injury with the patient and the record.
- Check for other coverage, such as a military or veterans program, that should pay.
- Correct and resubmit if the claim's injury details were entered wrong.
Related codes
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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