CO-177 — Patient hasn’t met eligibility requirements
Claim-adjustment reason code 177 · typically reported as CO-177 or PR-177
What it means
A plan-level eligibility condition isn’t satisfied — distinct from termination: the patient may be enrolled but not yet eligible for this benefit.
Why DME claims hit it
- Benefit waiting periods on commercial plans
- Medicaid spend-down not met for the month of service
How to fix it
- Check the specific eligibility condition in the 271/portal; rebill when/if satisfied
Appeal posture
Rarely — it’s an eligibility fact question.
Related denial codes
CO-26 — Expenses incurred before coverage beganCO-27 — Expenses incurred after coverage endedPR-31 — Patient cannot be identified as insured
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