CARC 58CO · Contractual Obligation
The payer determined the service shouldn't have been performed in the setting where it was billed.
- Common causes
- The procedure is restricted to certain settings by payer policy, such as an inpatient-only procedure billed from an outpatient clinic.
- Suggested fix
- Confirm the payer's site-of-service rules for this procedure and rebill from the correct setting if applicable, or appeal with justification for the setting used.
Related Contractual Obligation codes
107This claim depends on another related claim or service being referenced, but that link wasn't provided.11The diagnosis code doesn't support medical necessity for the procedure billed, based on the payer's coverage edits.13The claim shows a date of service after the patient's recorded date of death.146The diagnosis code billed wasn't a valid, active code as of the date of service.150The documentation submitted doesn't justify the complexity or level of the service billed, commonly seen with evaluation and management visit levels.16The claim is missing required information or contains a billing error that prevented the payer from processing it.170This payer doesn't reimburse this specific provider type for this service.171This payer doesn't cover this service when it's billed by this provider type in this particular facility setting.
Frequently asked questions
What does CARC 58 mean?
The payer determined the service shouldn't have been performed in the setting where it was billed.
How do I resolve CARC 58?
Confirm the payer's site-of-service rules for this procedure and rebill from the correct setting if applicable, or appeal with justification for the setting used.
Why does CARC 58 happen?
The procedure is restricted to certain settings by payer policy, such as an inpatient-only procedure billed from an outpatient clinic.
CARC codes maintained by X12 (x12.org). Descriptions on this site are original reference interpretations. Always verify codes with authoritative sources before making billing decisions.