835 Denial Combination

CO-58

CO

Contractual Obligation · Service-Line Level Adjustment

Coding Error

What This Combination Means

The payer has identified that the place of service code reported on the claim does not align with the service rendered or payer policy requirements. This is a contractual adjustment where the provider must absorb the cost due to the coding error. The payer may reference loop 2110 Service Payment Information REF in the 835 remittance for specific policy details about acceptable place of service codes for this procedure.

Financial Responsibility

provider writeoff

The provider must write off the adjusted amount as a contractual obligation resulting from submitting an invalid or inappropriate place of service code. The patient cannot be billed for this adjustment.

72%

Appeal Success

7-14 days (corrected claim) or 30-60 days (appeal)

Avg. Resolution

Medium

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-58 combination — not generic advice.

Appealable:This is appealable if the provider believes the place of service code was correctly reported based on where the service actually occurred and can demonstrate alignment with payer policy.
  1. 1

    Verify the place of service code reported on the claim against where the service was actually rendered

    Compare box 24B on the CMS-1500 or loop 2400 SV105 in the 837 against the actual service location to confirm accuracy

  2. 2

    Check the 835 remittance loop 2110 Service Payment Information REF segment for policy identification

    The payer may include specific policy references indicating which place of service codes are acceptable for the procedure billed

  3. 3

    If the place of service code was incorrect, submit a corrected claim with the appropriate place of service code that matches where service occurred

    Use claim frequency code 7 and include the correct place of service based on the actual rendering location

  4. 4

    If the place of service code was correct, file an appeal with documentation proving the service location and supporting why the reported code is appropriate

    Include facility records, attestations of service location, and cite payer policy language supporting the place of service for the specific procedure

Specialty Context

How CO-58 typically presents across different practice types.

Dental

Common when office procedures (POS 11) are billed but payer requires clinic designation (POS 22) or when inpatient hospital dental services (POS 21) are coded as office visits

Medical

Frequently occurs with telehealth services, surgical procedures performed in ASC versus office settings, or when E/M services in observation are coded as outpatient hospital versus office

Behavioral Health

Often seen when therapy services are billed with office POS (11) but payer requires community mental health center (53), or when partial hospitalization is coded incorrectly

Individual Code References

View the standalone definition for each code in this combination.

CARC 58

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Synthesized from official definitions — not from training data

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