CARC Code
5
Procedure Code Inconsistent with Place of Service
The service or procedure code you billed does not match the location where the service was provided. For example, billing for a procedure that requires a hospital setting but listing an office as the place of service.
codingHow to resolve this denial
▶✓ Pre-action checklist — verify before contacting the payer
Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.
▶More about CO-5 — stats, related codes, appeal template
82%
Recovery Rate
7-14 days
Avg. Resolution
Medium
Difficulty
Common
Frequency
Payer-Specific Notes
How major payers handle CARC 5 by specialty.
Aetna
Aetna uses CO-5 when procedure/diagnosis combination fails edit. Check RARC for specific field.
Common 835 Combinations
CARC 5 most often appears with these Group Code + RARC combinations on 835 remittances.
Appeal Letter Template
Generic appeal template for CARC 5 denials.
We are submitting a formal appeal for claim [CLAIM_NUMBER] for patient [PATIENT_NAME], date of service [DOS]. This claim was denied/adjusted with CARC 5 indicating: "The procedure code/bill type is inconsistent with the place of service.." We have reviewed the claim and are providing the attached documentation to support reconsideration. [SUPPORTING_DOCUMENTATION]. Please reconsider payment per the terms of our contract.
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