Denial Code 167 (CO-167, PR-167) — Meaning & What to Do
Claim Adjustment Reason Code (CARC)
What denial code 167 means: This diagnosis isn't covered by the plan.
What to do about denial code 167: If you believe this is wrong, you can appeal with supporting notes from your doctor.
CO-167 vs PR-167 vs OA-167: what the prefix means
| Code on your EOB | What the prefix means | Who typically pays |
|---|---|---|
| CO-167 | Contractual obligation — the provider writes the amount off | Usually not the patient |
| PR-167 | Patient responsibility | The patient |
| OA-167 | Other adjustment | Often another payer or plan |
The prefix tells you who is expected to absorb the amount; the number (167) tells you why.
Seeing denial code 167 on your EOB?
A denial code tells you what the payer reported, but it may not tell the whole story. Reviewing your EOB and bill together can help clarify what may need attention.
Related codes
CARC 152The information submitted doesn't support this length of service.
CARC 170Payment is denied when done by this type of provider.
CARC 151The information submitted doesn't support this many services.
CARC 181The procedure code was invalid on the date of service.
Keep reviewing your bill
- Medical Bill vs EOB: What Is the Difference?
- How to Dispute a Medical Bill — Find Billing Errors Before You Pay
- What Is an Itemized Medical Bill? How to Request One
Frequently asked questions about Denial code 167
What does denial code 167 mean on my EOB?
This diagnosis isn't covered by the plan.
What should I do about denial code 167?
If you believe this is wrong, you can appeal with supporting notes from your doctor.
Seeing this code on your own EOB?
Upload the EOB, the bill, or both — MD Bill Check reads the codes on your documents, compares them side by side, and flags what's worth questioning. Free, no account needed.