CO 174 denial code
Claim adjustment reason code 174. Often reported as CO 174.
Not prescribed before delivery
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 174 means
The payer will not pay because the order or prescription was dated after the service or item was delivered.
The payer requires the order to exist before the service is given or the item is delivered. Here, the order came later, so the service did not meet that rule.
Check the dates on the order and the delivery or service record. A later signature date on an earlier verbal order can cause this.
Group codes seen with 174
On a remittance, 174 comes after a group code. These are the ones it is most often reported with:
- CO 174 (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.
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 item was delivered before the written order was signed.
- A verbal order was not documented in writing until after delivery.
- The order date was entered wrong on the claim.
What to do next
- Compare the order date with the delivery or service date.
- Correct the date and resubmit if it was entered wrong.
- Make sure orders are signed and on file before delivery going forward.
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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