CO-150: Information Does Not Support Level of Service
Provider responsibility — gather documentation and appeal if the denial is in error. The patient is not liable for this amount.
What Does CO-150 Mean?
With CO (Contractual Obligation), the CARC 150 denial for information does not support level of service is the provider's contractual responsibility. The patient is not liable for this amount. However, the provider may appeal with supporting clinical or administrative documentation if the denial is believed to be in error.
CARC 150 indicates information does not support level of service. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.
Common scenarios that trigger this adjustment include: the clinical documentation does not demonstrate the medical necessity or complexity required to justify the level of service billed, such as billing a level 5 E/M when documentation supports only a level 3; The payer's review determined that the service was billed at a higher level than the documentation supports, resulting in a downgrade or denial; Required medical records, progress notes, or clinical documentation that would support the billed level of service were not submitted with the claim or upon request. The group code paired with CARC 150 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.
Common Causes
| Cause | Frequency |
|---|---|
| Insufficient documentation to support the billed level of service The clinical documentation does not demonstrate the medical necessity or complexity required to justify the level of service billed, such as billing a level 5 E/M when documentation supports only a level 3 | Most Common |
| Upcoding detected by payer The payer's review determined that the service was billed at a higher level than the documentation supports, resulting in a downgrade or denial | Most Common |
| Missing or incomplete medical records Required medical records, progress notes, or clinical documentation that would support the billed level of service were not submitted with the claim or upon request | Common |
| Payer's clinical guidelines differ from provider's assessment The payer applies stricter clinical criteria for the level of service than what the provider used, resulting in a determination that a lower level of service was appropriate | Common |
| Incorrect E/M level selection The provider selected the wrong E/M code level based on the documentation of medical decision-making, history, and examination complexity | Common |
How to Resolve
- Review the denial Examine the CO-150 denial and any RARC codes to understand the specific basis for the coverage determination.
- Gather supporting documentation Collect medical records, clinical notes, authorization documents, or other evidence that supports the medical necessity or coverage of the denied service.
- File the appeal Appeal with comprehensive clinical documentation including progress notes, medical decision-making details, time documentation, and any additional records supporting the billed level of service. Reference the payer's specific clinical criteria and explain how the documentation meets each requirement.
- Track the appeal outcome Monitor the appeal status and follow up as needed. If denied again, consider further levels of appeal if available.
Appeal with comprehensive clinical documentation including progress notes, medical decision-making details, time documentation, and any additional records supporting the billed level of service. Reference the payer's specific clinical criteria and explain how the documentation meets each requirement.
Common RARC Pairings
The RARC code tells you exactly what triggered the CO-150:
| RARC | Description |
|---|---|
| N130 | You may need to review plan documents or guidelines Review the payer's clinical guidelines for the billed level of service to understand the downgrade criteria → |
| M20 | Missing/incomplete/invalid HCPCS Verify the HCPCS or CPT code billed matches the documentation and resubmit if incorrect → |
How to Prevent CO-150
- Ensure clinical documentation thoroughly captures the complexity, medical decision-making, and time involved to support the billed level of service
- Train providers on payer-specific documentation requirements for each level of service
- Use coding compliance tools or auditing software to verify E/M level selection before claim submission
- Conduct regular internal coding audits to identify patterns of level-of-service mismatches
- Submit supporting documentation proactively with claims for higher-level services
- Stay current on payer-specific clinical policies and medical necessity criteria for level-of-service determinations
Also Filed As
The same CARC 150 may appear with different Group Codes:
Related Denial Codes
Sources
- https://www.mdclarity.com/denial-code/150
- https://www.sprypt.com/denial-codes/co-150
- https://x12.org/codes/claim-adjustment-reason-codes
- https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/ClaimDenialCodes.pdf
- Codes maintained by X12. Visit x12.org for official definitions.