CO-170 | Payment adjusted due to referral absence

Industry

Insurance

Canonical

/insurance/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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Hub

Guides

The Complete Insurance Claim Denial Codes Directory (2026 Edition)

Related Codes

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

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