Official CARC description: “Precertification/notification/authorization/pre-treatment exceeded.” Here’s what it actually means, why it fires, and how to get the claim paid.
An auth exists but this claim went past it — more visits, more units, or dates outside the window. The auth needs extending, or the excess needs clinical defense.
Liability group: CO = Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Also written: CO-198, CO198, “denial code 198”, “198 denial code” or “reason code 198” — same CARC, different ERA formatting.
Track auth utilisation live — request extensions BEFORE visits exhaust
Ask for a retro-extension with progress notes showing continued necessity
Date-window misses: sometimes just an auth-dates correction call
Split billing: within-auth lines paid, excess lines appealed
Appeal the excess with clinical progression documentation — payers grant retro-extensions when notes show necessity continued. Time-barred without notes, so document as you go.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
The official CARC description for CO 198 is: “Precertification/notification/authorization/pre-treatment exceeded.” In practice: An auth exists but this claim went past it — more visits, more units, or dates outside the window. The auth needs extending, or the excess needs clinical defense.
Denial code 198 under the CO group (Contractual Obligation) means: Precertification/notification/authorization/pre-treatment exceeded. The number is the reason; the CO prefix decides who is liable — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Yes. CO 198, CO-198, CO198 and “denial code 198” are the same CARC — clearinghouses, payer portals and PM systems just print it differently. Only the group prefix (CO, PR, OA or PI) changes the meaning, because it changes who has to absorb the amount.
CO stands for Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Appeal the excess with clinical progression documentation — payers grant retro-extensions when notes show necessity continued. Time-barred without notes, so document as you go.