CO-197 — Precertification / Authorization Absent

CO-197 is one of the most contested behavioral health denial codes. The payer denies because no prior authorization was obtained. Under MHPAEA, a prior authorization requirement for outpatient mental health visits — when no authorization is required for comparable outpatient medical visits — is an NQTL violation. Document the payer's authorization requirements for physical therapy, specialist visits, or cardiac rehab and compare. Request the NQTL comparative analysis under CAA 2021 § 203.