58Denial Code (CARC)Active
CO 58 Denial Code: Invalid Place of Service Fixes
Code 58 indicates that the payer determined the treatment was provided in an inappropriate or invalid place of service. This means the location where the service was performed does not match what the payer considers acceptable for that treatment.
Who Pays: Group Code Liability
The group code for code 58 is typically CO, meaning it's a contractual write-off and the patient cannot be billed for this adjustment. However, if the error is due to incorrect information provided by the patient, it might be PR, making it patient responsibility.
Why Claims Get Code 58
- The place of service code on the claim does not match the payer's acceptable locations for the procedure.
- The provider's contract with the payer does not cover services rendered at the billed location.
- Billing staff selected an incorrect place of service code during claim submission.
- The service was rendered at an unapproved facility.
- The payer's policy changed regarding acceptable places of service, and the billing office was not updated.
How to Fix & Resubmit
- Verify the place of service code on the claim matches the actual service location.
- Check the payer's policy or contract to confirm if the location is covered for the procedure.
- If the place of service was incorrect, correct it and submit a corrected claim.
- If the location is not covered, contact the payer to discuss options or appeal if appropriate.
- Ensure all documentation supports the billed place of service.
Corrected Claim or Appeal?
Submit a corrected claim if the place of service was billed incorrectly. If the billed location is correct but not covered, an appeal with supporting documentation may be necessary.
Preventing Future 58 Denials
- Ensure billing staff are trained on current place of service codes and payer policies.
- Regularly update the billing office with changes in payer policies regarding service locations.
- Implement a checklist for verifying place of service codes before claim submission.
- Maintain open communication with payers regarding acceptable service locations.