Quick Explanation
Denial code CO-66 indicates that the patient's specific three-pint blood deductible for the calendar year has not yet been met or replaced. Under Medicare guidelines, beneficiaries are responsible for the cost of the first three pints of unreplaced blood or packed red blood cells received, which is categorized as a deductible before insurance coverage applies.
Common Causes for CO-66
Denials with code CO-66 typically happen for the following specific reasons:
- The billing department submitted charges for the first three pints of blood before the patient's annual blood deductible was satisfied.
- The provider failed to report or document a blood replacement arrangement, where the patient or a donor replaces the blood units to waive the deductible.
- Incorrect application of institutional Value Codes on the UB-04 claim form, such as Value Code 06 (unreplaced blood pints) or Value Code 38 (blood deductible units).
- Failing to verify the patient's prior blood transfusions at other facilities within the current calendar year.
How to Prevent CO-66 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Verify the patient's prior transfusion history and Medicare eligibility during pre-admission to determine if the annual three-pint blood deductible has already been met.
- Implement and promote a blood replacement donation program, allowing patients or donors to replace utilized blood to satisfy the deductible.
- Accurately use UB-04 Value Codes 06, 37 (blood pints replaced), and 38 on institutional claims to communicate blood utilization to the payer.
- Ensure billing systems clearly differentiate between the billing of the blood product itself and the non-deductible blood processing and administration services.
Appeal Letter Template for CO-66
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO-66 - Blood deductible has not been met
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code CO-66: "Blood deductible has not been met".
We are requesting a redetermination for the denied blood services on this claim. Pursuant to CMS Medicare Claims Processing Manual Guidelines, the three-pint blood deductible applies solely to the cost of the blood product itself and does not apply to the administrative or processing charges associated with the transfusion. Our records indicate that the patient either satisfied the three-pint blood deductible earlier in the calendar year or the blood was replaced through an authorized donor program represented by Value Code 37. Therefore, the deductible has been satisfied or offset, and the charges should be processed for payment under standard program benefits. We request that the claim be reprocessed and paid accordingly.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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