CO-5
CO · Contractual Obligation
CO-5 Denial Code: Procedure or bill type doesn't fit the place of service
The procedure is not payable for the place of service (POS) reported - for example an inpatient-only procedure billed with an office POS. Verify and correct the POS or the code.
- Group code
- CO - Contractual Obligation
- Code type
- CARC
- Billable to patient?
- No - correct and resubmit
- Appealable?
- No - correct the place of service and resubmit
- Category
- Coding Consistency
- Common pairing
- M77
On a remittance
CAS*CO*5*125.00On a paper EOB it shows as CO-5.What CO-5 means
CO-5 means the place of service on the claim does not match where the procedure can be performed or paid. It is common when the POS code is wrong, or a procedure restricted to a facility setting is billed as office (or vice versa). Confirm the actual site of service and correct the POS or the procedure code.
Common causes
- The place-of-service code was entered incorrectly.
- The procedure is only payable in a specific setting (facility vs office).
- A facility/professional split was billed with the wrong POS.
How to fix it
- Verify the actual site of service and the correct POS code.
- Correct the POS (or procedure) and resubmit a corrected claim.
- If the POS and procedure were correct, check the payer's policy and appeal with documentation.
How to prevent it
- Validate POS against the procedure at charge entry.
- Maintain a reference of setting-restricted procedures.
- Confirm the POS mapping from your scheduling/EHR feed.
No - correct the place of service and resubmitUsually a correct-and-resubmit. Appeal only if the POS and procedure were correct and payer policy supports payment in that setting.