How do I resolve a CO-5 denial?

Verify the actual location where the service was rendered — this should match your provider's documentation and encounter record. Cross-reference the CPT code with the acceptable POS codes per the Medicare Physician Fee Schedule or payer's policy. Correct the POS code on the claim to accurately reflect the service location. Resubmit as a corrected claim with the correct POS code. For telehealth: confirm which POS is required based on where the patient was located at the time of service (POS 02 = patient at a health facility, POS 10 = patient at home).

Can I appeal a CO-5 denial?

Yes. CO-5 denials are typically appealable with a 82% success rate. Resolution difficulty is Easy and typically takes 5-10 days.

835 Denial Combination

CO-5

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

The procedure is inconsistent with the place of service (POS). The service billed is not typically performed or covered in the setting indicated on the claim. For example, a procedure normally performed in an outpatient facility billed with an office POS, or a telehealth service billed with the wrong POS code.

82%

Appeal Success

5-10 days

Avg. Resolution

Easy

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-5 combination — not generic advice.

1
Verify the actual location where the service was rendered — this should match your provider's documentation and encounter record.
2
Cross-reference the CPT code with the acceptable POS codes per the Medicare Physician Fee Schedule or payer's policy.
3
Correct the POS code on the claim to accurately reflect the service location.
4
Resubmit as a corrected claim with the correct POS code.
5
For telehealth: confirm which POS is required based on where the patient was located at the time of service (POS 02 = patient at a health facility, POS 10 = patient at home).

Specialty Context

How CO-5 typically presents across different practice types.

Dental

Dental procedures are typically POS 11 (office). Procedures performed in a hospital setting for medically compromised patients must be billed with the appropriate facility POS.

Medical

Common errors: billing POS 11 (office) for services rendered in an Ambulatory Surgery Center (POS 24) or hospital outpatient (POS 22), or billing POS 02 (telehealth, patient not at home) for services now requiring POS 10.

Behavioral Health

Telehealth POS is the most common trigger — POS 02 vs. POS 10 for audio-only vs. audio-video telehealth. CMS updated requirements in 2023.

Individual Code References

View the standalone definition for each code in this combination.

CARC 5

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