CO-60: Outpatient Services Not Covered Near Inpatient Stay

What Does CO-60 Mean?

With CO (Contractual Obligation), the CARC 60 adjustment for outpatient services not covered near inpatient stay 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 60 indicates outpatient services not covered near inpatient stay. The payer's adjudication logic determined that this service or procedure is included within another service that was billed on the same claim or a related claim.

Common scenarios that trigger this adjustment include: outpatient services provided within 3 days (1 day for non-IPPS hospitals) before an inpatient admission are bundled into the inpatient DRG payment; Outpatient services within the payment window after inpatient discharge are bundled into the inpatient claim; Pre-admission tests performed near the admission date are included in the inpatient payment. The group code paired with CARC 60 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 adjustment against contract terms Compare the CO-60 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 If the outpatient services are unrelated to the reason for inpatient admission, appeal with medical records demonstrating the services address a different condition. Include condition code 51 on resubmission. For Medicare, reference the 3-day payment window rule exceptions.
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-60:

How to Prevent CO-60

• Be aware of the 3-day (or 1-day) payment window rule
• Include pre-admission outpatient services on the inpatient claim when related
• Use condition code 51 to identify unrelated outpatient services
• Coordinate outpatient and inpatient billing to avoid payment window denials
• Train billing staff on inpatient/outpatient bundling rules

Also Filed As

The same CARC 60 may appear with different Group Codes:

Related Denial Codes