CARC 60 Active

OA-60: Outpatient Services Not Covered Near Inpatient Stay

TL;DR

Adjustment in a COB or secondary payer context. Review the coordination of benefits details to determine the responsible party.

Action
Review & Decide
Who Pays
Depends
Appeal
Yes
Patient Impact
Indirect
Disclaimer
This content is for informational purposes only and does not constitute professional billing advice. Always verify information against your payer contracts and current coding guidelines. Consult a certified billing specialist for specific claim issues.

What Does OA-60 Mean?

With OA (Other Adjustments), CARC 60 typically appears in a coordination of benefits (COB) context. Secondary payer applies similar bundling rules. The financial responsibility depends on the specific arrangement between payers — review the primary payer's EOB and the COB terms to determine the correct course of action.

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

Cause Frequency
Secondary payer payment window rule Secondary payer applies similar bundling rules Most Common

How to Resolve

  1. Review the coordination of benefits Examine the OA-60 adjustment to understand how it fits within the primary/secondary payer relationship or other multi-payer context.
  2. Verify primary payer adjudication Review the primary payer's EOB to understand the basis for the secondary payer's OA adjustment.
  3. Determine the responsible party Based on the COB review, identify whether the adjustment should be absorbed, billed to another payer, or if additional documentation is needed.
  4. Appeal or resubmit if needed Appeal with documentation showing outpatient services are unrelated to the inpatient admission.
  5. Follow up Monitor the claim status and take additional action as needed based on the COB determination.
Appeal Guide

Appeal with documentation showing outpatient services are unrelated to the inpatient admission.

Common RARC Pairings

The RARC code tells you exactly what triggered the OA-60:

RARC Description
N381 Consult contract/fee schedule Review secondary payer bundling rules →

How to Prevent OA-60

Also Filed As

The same CARC 60 may appear with different Group Codes:

CO-60 PR-60

Related Denial Codes

OA-1 — Deductible Amount OA-2 — Coinsurance Amount OA-3 — Co-payment Amount OA-24 — Charges Covered Under Capitation/Managed Care OA-40 — Charges Do Not Meet Emergent/Urgent Care Qualifications

Sources

  1. https://x12.org/codes/claim-adjustment-reason-codes
  2. https://revenuecyclemgmt.com/claim-adjustment-reason-codes/
  3. https://www.rivethealth.com/blog/carcs-rarcs-claim-adjustment-remittance-advice-codes
  4. Codes maintained by X12. Visit x12.org for official definitions.