DenialCodePro
P16Denial CodeGeneral Adjustment

Code P16

Problem Description

Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only. (Use with Group Code CO or OA)

Actionable Fix — Solution Steps

Verify claim details and patient demographics. Submit a corrected claim or appeal with necessary supporting medical documentation.

Related Codes in General Adjustment

1

Deductible Amount

2

Coinsurance Amount

3

Co-payment Amount

6

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.

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