CO-5 denial code
The procedure code, or the type of bill, doesn't fit the place of service on the claim.
“The procedure code/type of bill is inconsistent with the place of service. …”
Start 01/01/1995 · Last modified 03/01/2018 · X12 adjustment reason code list
What it usually means in behavioral health
Behavioral health has its own places of service: 52 (psychiatric facility, partial hospitalization), 53 (community mental health center), 55 (residential substance abuse treatment facility), 56 (psychiatric residential treatment center), 57 (non-residential substance abuse treatment facility), plus 02 and 10 for telehealth.
Mixing them up, or using a place of service the payer doesn't allow for the code, produces CO-5.
Common causes
- Telehealth billed with POS 02 when the payer expects POS 10 for a patient at home, or the reverse
- Program services billed with an office POS instead of the facility POS
- A procedure code the payer doesn't allow in the place of service billed
- Facility type of bill inconsistent with the services on the claim
Correct and resubmit, or appeal?
Correct and resubmit with the place of service that matches where the service happened and what the payer allows for that code.
What to do
Confirm where the service actually took place, including the patient's location for telehealth.
Check the payer's rules for the code in that place of service.
Correct the place of service or type of bill and resubmit.
Often seen with
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