How do I resolve a CO-198 denial?

Pull the original authorization request and approval (if any) Determine whether a retroactive authorization request is an option with this payer See full resolution steps at tryarceum.com.

Can I appeal a CO-198 denial?

Yes. Most CO-198 denials can be appealed within 60-180 days depending on payer. This is appealable if you can demonstrate medical necessity for the additional services or if a valid authorization extension was obtained. Use our free tool to generate an appeal letter.

CARC Code

198

🔴 Hard Denial

Authorization Limit Exceeded

The services provided went beyond what was approved in the original authorization, precertification, or pre-treatment notification. The payer approved a certain number of visits or units, but more were billed.

authorization

Resolution: 35%Hard difficulty21-45 days avg

How to resolve this denial

Which payer denied this claim?

Request extension or retroactive authorization; appeal with clinical documentation

1
Pull the original authorization request and approval (if any)
2
Determine whether a retroactive authorization request is an option with this payer
3
Prepare clinical documentation supporting medical necessity for the service
4
Submit the retroactive authorization request through the payer portal
5
Submit a formal appeal once the authorization is obtained or denied
6
Document all communication with the payer in the patient account

Resolve this denial →

▶✓ Pre-action checklist — verify before contacting the payer

Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.

▶More about CO-198 — stats, related codes, appeal template

35%

Recovery Rate

21-45 days

Avg. Resolution

Hard

Difficulty

Common

Frequency

Payer-Specific Notes

How major payers handle CARC 198 by specialty.

Blue Cross Blue Shield

BCBS requires appeal submission within 180 days for most plans.

Common 835 Combinations

CARC 198 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-198Services were authorized but the billed units or amount exceeded the authorizedAppealable COCO-198+N133This combination indicates that the provider exceeded the authorized units orAppealable COCO-198+N130Services were provided beyond the scope, duration, or limits of an approvedAppealable

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 198 denials.

We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 198 indicating: "Precertification/authorization exceeded.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.

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