CO-158: Service Provided Outside the United States

What Does CO-158 Mean?

With CO (Contractual Obligation), the CARC 158 adjustment for service provided outside the united states is a contractual reduction. The provider absorbs this amount per the payer contract or regulatory payment methodology. The patient is not responsible for the adjusted amount. Review the remittance to confirm the adjustment is consistent with your contract terms.

CARC 158 indicates service provided outside the united states. 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's insurance policy does not cover medical services provided in foreign countries, and the payer denies the claim based on the service location; The claim was submitted with a place of service code or address indicating the service was rendered outside the US, even though it may have been provided domestically; A telemedicine consultation was provided by a provider located outside the United States, and the payer's policy excludes foreign-based telehealth services. The group code paired with CARC 158 determines who bears the financial responsibility — CO places it on the provider as a contractual obligation, PR shifts it to the patient, OA indicates a coordination of benefits or other payer adjustment.

Common Causes

How to Resolve

1. Review the adjustment against contract terms Compare the CO-158 adjustment with your payer contract to confirm the reduction is consistent with agreed terms or regulatory methodology.
2. Verify the adjustment amount Confirm the dollar amount of the adjustment is calculated correctly based on the contracted rate and the service provided.
3. Appeal if the adjustment is incorrect Appeal if the service was provided in the US and the location was reported incorrectly, or if the plan includes emergency out-of-country coverage. Include corrected claim information, provider address verification, or emergency documentation as applicable.
4. Process the contractual adjustment If the adjustment is correct per contract terms, process it accordingly in your billing system. This amount cannot be transferred to the patient.

Common RARC Pairings

The RARC code tells you exactly what triggered the CO-158:

How to Prevent CO-158

• Verify place of service codes and provider addresses on claims before submission to ensure accuracy
• Advise patients traveling internationally to check their coverage for out-of-country medical services
• For plans with emergency out-of-country coverage, document the emergency nature of services at the time of treatment
• Maintain awareness of each payer's policy on out-of-country service coverage

Also Filed As

The same CARC 158 may appear with different Group Codes:

Related Denial Codes