Denial code · group CO
CO-5: The place of service or bill type does not fit the procedure code on the line
Short answer
Denial code CO-5 means the payer matched the procedure code against the setting the claim reports, the place of service on an 837P or the type of bill on an 837I, and the pair failed its edit. Nobody looked at the care itself. One field is usually wrong, often a telehealth, facility or home setting, so the fix is a corrected claim that carries the setting the record shows.
Look up other codes in the denial code library.
Last reviewed by the Remitwright billing team. Editorial policy
Group CO means contractual obligation: the balance is written off, not billed to the patient. The number is the reason; the two-letter group says who carries the balance.
Remark codes that usually come with CO-5
- M77
- The place of service on the line is blank, invalid or not one the payer accepts for that code
- N56
- The payer considers the procedure code wrong for the service as it was billed
Common causes
Telehealth visits sent with an in-person setting
The CMS place of service code set has two telehealth values: 02 when the patient is somewhere other than home and 10 when the patient is at home. A video visit that leaves with 11 (office), or with 02 when the patient was at home, fails the payer's setting edit. Payers do not all accept the same value, so the rule lives in each payer's telehealth policy.
Hospital outpatient or facility visits billed as office
A physician who sees patients in a hospital outpatient department has two values in the CMS set, 19 for off campus and 22 for on campus, and a skilled nursing facility visit uses 31. When the practice management system ties every charge to the clinic, those visits go out with 11 and the edit rejects the pairing.
A code family written for one setting
Some evaluation and management families exist for a single setting only, such as home, nursing facility or emergency department visits. Billing one of them with an office or inpatient place of service is the classic CO-5. The coder picked the right family; the claim template did not follow.
A bill type that contradicts the lines
On institutional claims the edit runs against the type of bill. An outpatient HCPCS line on an inpatient bill type, or a home health line on a hospital outpatient bill, is inconsistent in the same way and comes back with the same reason code.
Clinicians who work at more than one site
A provider who covers two clinics and a facility gets one default location in the system. Every visit at the other sites inherits it until someone sets the location per encounter.
How to fix it and resubmit
- 1
Find where the patient actually was
Take the setting from the visit note, the facility census or the telehealth log, not from the scheduler. For video visits, the patient's location during the visit decides between 02 and 10.
- 2
Check the code set and the payer's rule
CMS maintains the place of service list and tells providers to confirm payment policy with each payer. Pull the payer's telehealth or facility policy for the code and confirm which value it pays before you touch the claim.
- 3
Send a corrected claim
Change the place of service, or the type of bill on a UB-04, and send a replacement claim that references the original claim number. Change only the field the edit flagged and leave the rest of the claim as it was.
- 4
Appeal only if the setting was already right
If the claim already shows the value the payer's own policy names for that code, call provider services with the policy reference, then file a written appeal if the representative cannot reprocess it. Resending the same claim unchanged will deny again.
How to prevent it
- A default place of service per location and per visit type (in person, video at home, video elsewhere) set up in the practice management system
- A scrubber rule that blocks setting-specific code families from going out with a place of service they do not allow
- A payer table of accepted telehealth place of service values, refreshed whenever a payer reissues its telehealth policy
- A separate location record for every facility a clinician covers, so the charge carries the right setting from the start
Nursing facility rounds billed from the clinic location
An internist rounds at a skilled nursing facility every Tuesday. Her charges are entered under the clinic location, so the facility visit codes go out with place of service 11. The payer returns CO-5 with M77 on each line. The biller checks the facility census to see which patients were on the skilled unit and which were on the long-term unit, sets 31 or 32 for each, and sends replacement claims. The practice then adds the facility as its own location so Tuesday charges carry the right setting.
Official text: the X12 claim adjustment reason code list. The meaning above is our paraphrase for billers; the list is the authority.
FAQ
Questions about CO-5
Is CO-5 the same as being paid the facility rate?
Which place of service do I use for telehealth?
Can CO-5 show up on a UB-04 claim?
Should I appeal a CO-5?
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