How do I fix or resolve code 170?

Verify the rendering provider's taxonomy code, specialty, and scope of practice against the CPT/HCPCS code billed to determine whether the provider is eligible to perform and bill the service. Check the provider's credentialing and enrollment status with the payer to confirm the provider is enrolled for the specific service type. If the wrong rendering provider was entered on the claim, correct the provider information and resubmit the claim with the appropriate rendering provider NPI. If the service was performed by an eligible provider but billed under the wrong provider type, correct the billing provider information and resubmit. If the provider is genuinely not eligible to perform the service (e.g., scope of practice limitation), write off the balance or determine whether the service can be rebilled under a supervising provider if the payer's rules allow.

170Denial CodeGeneral Adjustment

Code 170

Problem Description

Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

Root Cause

Payment is denied because the service was performed or billed by a type of provider that is not eligible to perform or bill for the service. The payer's editing system cross-references the CPT/HCPCS code against the provider's taxonomy code (specialty) or provider type and denies the claim when the provider is not credentialed or contracted to perform that service. Common examples include a primary care physician billing a surgical procedure, a non-physician provider billing a service outside their scope of practice, or a facility billing a professional service that only an individual provider can bill. This is a provider eligibility/scope-of-practice denial.

Resolution Steps

1Verify the rendering provider's taxonomy code, specialty, and scope of practice against the CPT/HCPCS code billed to determine whether the provider is eligible to perform and bill the service.
2Check the provider's credentialing and enrollment status with the payer to confirm the provider is enrolled for the specific service type.
3If the wrong rendering provider was entered on the claim, correct the provider information and resubmit the claim with the appropriate rendering provider NPI.
4If the service was performed by an eligible provider but billed under the wrong provider type, correct the billing provider information and resubmit.
5If the provider is genuinely not eligible to perform the service (e.g., scope of practice limitation), write off the balance or determine whether the service can be rebilled under a supervising provider if the payer's rules allow.

EHR Documentation Note

Claim denied 170 — provider type not eligible for service; verified provider taxonomy and scope of practice, corrected rendering provider, or wrote off as scope limitation.

Preventative Action

Maintain a provider-to-service eligibility matrix in the practice management system and validate the rendering provider's scope of practice against the billed CPT code at the point of charge entry.

Related Codes in General Adjustment

Deductible Amount

Coinsurance Amount

Co-payment Amount

The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.