Notes on payer behavior
CO-170 and CO-171 denial codes: not payable for this type of provider
Denial codes CO-170 and CO-171 are the payer saying: "CO-170: Payment is denied when performed/billed by this type of provider. CO-171: Payment is denied when performed/billed by this type of provider in this type of facility." What that means for your practice, and whether it's worth chasing, below.
What the payer is asserting
The service is fine and the patient is covered. The problem is who billed it. CO-170 says this provider type can't be paid for this service under the plan. CO-171 adds a setting: this provider type can't be paid for this service in this kind of facility. In an independent surgical practice the provider type in question is nearly always a physician assistant or nurse practitioner, and occasionally a therapist, an athletic trainer, or a physician whose enrollment with the payer doesn't cover the specialty billed.
What it usually is
- The extender isn't enrolled or credentialed with the payer. The claim went out under the PA's NPI before the payer's enrollment was effective. This is the same family as CO-B7 and the fix is the same: get the effective date, then reprocess everything from that date forward.
- The payer wants the service billed under the supervising physician. Some plans don't credential extenders and expect their work billed incident-to or under the physician's number with a modifier. Others require the extender's own NPI. Billing it the wrong way for that payer produces a CO-170 that a corrected claim fixes.
- Assistant at surgery. A PA assisting in the operating room billed with modifier 80 instead of AS, or billed for a procedure the payer's assistant-at-surgery list doesn't cover. Florida Blue pays non-contracted extenders "at 85 percent of the contracted provider's rate where a RVU exists" and decides assistant-at-surgery eligibility by payment policy. Its extender rules.
- A setting rule. CO-171 fires when an extender bills a service the plan pays only when a physician performs it in a facility, or when a physician bills a facility-only service from an office place of service. Check the place-of-service code first; a wrong POS produces a CO-171 that has nothing to do with the provider.
- Scope of practice. Rarely, the service genuinely sits outside what the plan covers for that license. That one isn't recoverable.
Is it recoverable?
Usually, and it is documentary. Enrollment gap: reprocess from the effective date. Wrong billing convention: corrected claim under the right NPI or with the right modifier. Wrong place of service: corrected claim. The trap is timing. A credentialing application that takes ninety days while the extender sees patients builds ninety days of CO-170s, and some of them will cross the payer's corrected-claim window before the enrollment comes through. Hold the claims rather than sending them to be denied, and diary the effective date.
Workers' comp
Florida workers' comp has its own version, EOBR code 26, "service rendered by healthcare practitioner outside scope of practitioner's licensure," and pays non-physician surgical assistants at "seventy-five percent (75%) of twenty-five percent (25%) of the physician MRA" with modifier AS, where the carrier has determined the assistant meets state licensure. The manual's rules.
Questions people ask about CO-170 and CO-171
What does denial code CO-170 mean?
The payer won't pay for this service when it is performed or billed by this type of provider. In practice it usually means a physician assistant or nurse practitioner who isn't enrolled with the payer, or a service billed under the wrong provider convention for that plan.
What is the difference between CO-170 and CO-171?
CO-171 adds the setting: the provider type isn't payable for this service in this type of facility. A wrong place-of-service code is a common cause, so check that before assuming a credentialing problem.
How do you fix a CO-170 denial?
Confirm the provider's enrollment effective date with the payer and reprocess claims from that date. If the payer expects the service billed under the supervising physician or with a specific modifier, submit a corrected claim that way. Hold claims for a provider whose enrollment is pending rather than sending them to be denied.