ABA Buyer Intent Guide
CO-197 means the service needed a precertification or authorization that was not on file. In ABA it is the single most common denial, and it is one of the most preventable, because it is a workflow problem before it is a billing problem.
Quick answer
CO-197 is the denial for an absent authorization or precertification, and it is the most common single ABA denial code. The structural fix is authorization tracking that gates scheduling and documentation in real time, so a session cannot be booked or billed against an expired or exhausted authorization. This is not billing or legal advice.
CO-197 signals that the payer required an authorization or precertification that was not present when the service was rendered. That can mean the authorization expired, was exhausted, never covered the code billed, or was never obtained. It is common in ABA because authorizations are unit-limited and time-boxed, and a busy schedule can quietly outrun them.
By the time CO-197 shows up on a remittance, the hour is already delivered and unpaid. The durable fix is upstream: track each authorization’s remaining units and dates, and let the schedule refuse to book past what is authorized. In the Infinite Suite OS demo, the Auth Utilization War Room surfaces authorizations at risk and the Claims Gate refuses any claim without an active authorization, a signed note, EVV, and a current credential. Both are labeled demo capabilities on fictional data.
CO-197 is the claim adjustment code for a precertification, authorization, or notification that was absent. In ABA it usually means the authorization expired, was exhausted, or did not cover the billed code, so the payer will not pay the claim.
ABA authorizations are limited by units and by date, and high session volume can outrun them. Without real-time tracking, sessions get scheduled and delivered against an authorization that no longer has room, which produces CO-197 on the claim.
Track remaining authorized units and dates in real time and gate scheduling against them, so a session cannot be booked past what is authorized. Preventing the denial at the schedule is far cheaper than appealing it after the hour is already delivered.
Denial codes and payer rules vary by plan and state. Figures describe common industry patterns, not a specific clinic. This page is general information, payer-neutral, and is not billing or legal advice.