CO-117: Transportation to Nearest Facility

What Does CO-117 Mean?

With CO (Contractual Obligation), the CARC 117 adjustment is the provider's responsibility. The payer denied or reduced payment because of the patient was transported by ambulance to a facility that was not the nearest appropriate facility, and the payer only covers transport to the closest facility that can provide the needed care. The patient is not liable for this amount. If the denial is in error, the provider can correct and resubmit the claim or file an appeal with supporting documentation.

CARC 117 indicates transportation to nearest facility. The payer determined that the service or a portion of it does not meet coverage criteria under the patient's current plan benefits or the applicable coverage rules.

Common scenarios that trigger this adjustment include: the patient was transported by ambulance to a facility that was not the nearest appropriate facility, and the payer only covers transport to the closest facility that can provide the needed care; The medical necessity for transporting to a farther facility (e.g., specialized care not available at the nearest facility) was not documented on the claim; For non-emergency transport, the payer limits coverage to the nearest facility unless medical necessity for the specific distant facility is documented. The group code paired with CARC 117 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, OA indicates a coordination of benefits or other payer adjustment, PR shifts it to the patient.

Common Causes

How to Resolve

1. Review the remittance details Examine the CO-117 adjustment and any accompanying RARC codes to identify the specific reason for the denial.
2. Identify the root cause Determine which issue applies: transport to facility farther than nearest appropriate facility, missing documentation of medical necessity for distant transport, non-emergency transport to distant facility, among others.
3. Correct the claim Address the identified issue — update the claim data in your billing system to resolve the transportation to nearest facility problem.
4. Resubmit the corrected claim Submit the corrected claim following the payer's resubmission guidelines. Include any supporting documentation that addresses the denial reason.
5. Appeal if the original claim was correct Appeal with a physician certification statement explaining why the nearest facility could not provide the needed level of care. Include documentation of the patient's medical condition, the specific services required at the destination facility, and evidence that those services were not available closer. For Medicare, file within 120 days.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-117:

How to Prevent CO-117

• Document the medical necessity for transporting to a specific facility when it is not the nearest appropriate one
• Include physician certification of transport necessity with all ambulance claims
• Maintain records of the nearest appropriate facility for common transport origins
• Ensure ambulance billing includes the correct origin, destination, and mileage
• Train dispatch and billing staff on payer rules for nearest facility transport limitations

Also Filed As

The same CARC 117 may appear with different Group Codes:

Related Denial Codes