Healthcare Error Code
Healthcare Insurance / Medical Billing
Claim Adjustment Reason Codes (CARC)
CO-170 | Payment adjusted due to referral absence
Industry
Healthcare
Canonical
/healthcare/error-codes/co-170/
Last Updated
Feb 25, 2026
Summary
This code indicates that payment was adjusted because a required referral was not present.
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What This Code Means
CO-170 is used when a payer requires a referral for coverage and no valid referral is on file. This is a benefit management requirement tied to plan rules. The code does not reflect service quality or billing accuracy. Coverage eligibility may depend on referral compliance.
Where Users Usually See This Code
- EOB statements
- Remittance advice
- Referral review summaries
Why This Code Appears
- Required referral not obtained
- Referral information missing or invalid
- Referral did not match the service
What Typically Happens Next
- Payment is denied or reduced
- Claim processing completes
- Appeal options may exist
What This Code Is Not
- It is not a documentation format error
- It is not a duplicate claim
- It is not a contractual adjustment
Troubleshooting Checklist
- □ Review referral requirements
- □ Confirm referral validity
- □ Monitor plan referral policies
Notes And Edge Cases
Referral requirements vary by plan type. Emergency services may follow different rules.
Related Codes
8 links
- CO-167 CodeNo authorization on file
- CO-197 CodePrecertification required
- CO-54 CodeMultiple physicians not allowed
- CO-133 CodeIncorrect provider type
- CO-65 CodeProcedure code invalid
- CO-151 CodePayment adjusted due to contractual agreement
- CO-27 CodeCoverage terminated
- CO-62 CodeNot covered for place of service
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