Denial Code 197 (CO-197, PR-197) — Meaning & What to Do
Claim Adjustment Reason Code (CARC)
What denial code 197 means: Pre-authorization or pre-certification was required but not obtained.
What to do about denial code 197: If authorization was actually obtained (or wasn't your responsibility), appeal with proof.
CO-197 vs PR-197 vs OA-197: what the prefix means
| Code on your EOB | What the prefix means | Who typically pays |
|---|---|---|
| CO-197 | Contractual obligation — the provider writes the amount off | Usually not the patient |
| PR-197 | Patient responsibility | The patient |
| OA-197 | Other adjustment | Often another payer or plan |
The prefix tells you who is expected to absorb the amount; the number (197) tells you why.
Related codes
CARC 119A benefit maximum or limit for this service has been reached.
CARC 204This service isn't covered under your current benefit plan.
CARC 109This claim was sent to the wrong insurer or plan.
CARC 252Additional documentation is needed to process the claim.
Keep reviewing your bill
- Medical Bill vs EOB: What Is the Difference?
- How to Dispute a Medical Bill — Find Billing Errors Before You Pay
Frequently asked questions about Denial code 197
What does denial code 197 mean on my EOB?
Pre-authorization or pre-certification was required but not obtained.
What should I do about denial code 197?
If authorization was actually obtained (or wasn't your responsibility), appeal with proof.
Found this code on your bill or EOB?
Upload the document — MD Bill Check decodes every code, checks the math line by line, and explains what's worth questioning.