CARC 5: The procedure code/type of bill is inconsistent with the place of service.
The procedure code/type of bill is inconsistent with the place of service.
CARC 5 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
What CARC 5 means
The official X12 description is: “The procedure code/type of bill is inconsistent with the place of service.”
In plain language: The procedure code/type of bill is inconsistent with the place of service.
What to do next 5
Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
DenialHelp helps organize a source-linked draft from the denial notice and confirmed case facts. The patient and treating clinician must verify the governing review rule, current payer policy, clinical sources, attachments, destination, and deadline.
CARC 5 group codes explained
On the 835 ERA, CARC 5 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 5 mean?
The procedure code/type of bill is inconsistent with the place of service. In plain language: The procedure code/type of bill is inconsistent with the place of service.
Is CARC 5 appealable?
Yes — CARC 5 is one of the codes that commonly supports an appeal. Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
Which group code does CARC 5 appear under?
CARC 5 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
How do I appeal a CARC 5 denial?
Appeal with documentation specific to this code. The provider's billing office can help clarify what the carrier wants.
Related resources
Sources
Appeal a CARC 5 denial
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