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.
Seeing denial code 197 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 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
- What Is an Itemized Medical Bill? How to Request One
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.
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.