Procedure code does not match the place of service
The service billed cannot be done, or cannot be paid, in the place of service shown on the claim.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- Wrong place of service code (for example 11 office instead of 22 outpatient hospital or 02 and 10 for telehealth).
- A facility-only code billed with an office place of service, or the reverse.
- Telehealth visit billed without the telehealth place of service or modifier the payer requires.
The fix
Confirm where the service happened and the payer's telehealth rules, correct the place of service (and the modifier if the payer wants one), then send a corrected claim.
Appeal or corrected claim?
Corrected claim in almost every case.
Deadline to watch
Timely filing limit from the date of service.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
CO-5 in short
What does CO-5 mean?
The service billed cannot be done, or cannot be paid, in the place of service shown on the claim. The official X12 text reads: "The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."
What usually causes a CO-5 denial?
Wrong place of service code (for example 11 office instead of 22 outpatient hospital or 02 and 10 for telehealth). A facility-only code billed with an office place of service, or the reverse. Telehealth visit billed without the telehealth place of service or modifier the payer requires.
How do I fix CO-5?
Confirm where the service happened and the payer's telehealth rules, correct the place of service (and the modifier if the payer wants one), then send a corrected claim.
Should I appeal CO-5 or send a corrected claim?
Corrected claim. Corrected claim in almost every case.
What deadline applies to CO-5?
Timely filing limit from the date of service.