CO 158 denial code
Claim adjustment reason code 158. Often reported as CO 158 or PR 158.
Service provided outside the United States
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What 158 means
The service was given outside the United States, and the plan does not cover it in that location.
Some plans do not pay for care given outside the country, or cover it only in limited cases. This code means the payer applied that location rule to your claim.
If the service was actually given in the United States, the address or place of service data is likely wrong. If it was given abroad, check the plan's foreign travel benefits.
Group codes seen with 158
On a remittance, 158 comes after a group code. These are the ones it is most often reported with:
- CO 158 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.
- PR 158 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.
The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.
Common causes
- The patient was treated outside the United States and the plan excludes foreign care.
- The service facility address on the claim was outside the country.
- A data error made the payer think the service was given outside the country.
What to do next
- Check the service facility address and place of service on the claim.
- Correct and resubmit if the location data was wrong.
- Ask the payer about any foreign travel or emergency coverage the plan offers.
Related codes
- 157 (reason code) Service resulted from an act of war
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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