Skip to main content

CO-171 Denial Code: Provider Type Not Paid in This Facility

CO-171 means the service was denied because of the combination of provider type and facility type. The provider may be payable elsewhere, and the facility may be fine for other providers, but this pairing is not payable under the payer's policy.

Quick facts

Code
CO-171 (CARC 171)
Status
Active In use since June 30, 2005; last modified July 1, 2017.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The provider is responsible for the denied amount and cannot bill a network patient for it.
  • PR (Patient Responsibility): Uncommon. The plan may assign the amount to the patient if the member chose an out-of-network setting the plan does not cover for that provider type.
Official description
Payment is denied when performed/billed by this type of provider in this type of facility. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-171 means

CARC 171 reads “Payment is denied when performed/billed by this type of provider in this type of facility.” This is a combined rule: the payer’s policy links provider types to settings. A provider type may be payable in one setting and not another, or a facility may only allow certain types of practitioners to bill separately.

The usage note directs you to the 835 Healthcare Policy Identification segment (loop 2110 REF), which may name the specific policy.

Example: a therapist whose services a plan pays in an outpatient office also treats a patient during an inpatient stay. The plan considers those services part of the facility’s payment and does not pay the therapist separately in that setting, so the professional claim is denied CO-171.

Common causes

  • Services bundled into a facility payment for certain settings (inpatient, SNF, residential), where only some provider types can bill separately.
  • Place of service code in box 24B incorrect, making the setting look different from reality.
  • Service facility NPI or address in box 32 tied to a facility type the payer restricts.
  • Provider not credentialed for that location or facility category.
  • Payer policies for telehealth that restrict certain provider types at certain originating sites.

How to fix it

  1. Confirm the actual setting and compare it to the POS code and service facility on the claim.
  2. Read the payer policy in the REF segment or provider manual to see which provider types can bill in that setting.
  3. If POS or facility data was wrong, submit a corrected claim (resubmission code 7 in box 22).
  4. If the facility should bill, coordinate with the facility so the service is included on its claim, as the payer’s rules require.
  5. If you believe the policy allows the service, appeal with the policy citation and your credentialing documentation.

How to prevent it

  • Verify credentialing by location, not just by provider, before clinicians start seeing patients at a new site.
  • Map settings to POS codes carefully in your scheduling and billing system, especially for outreach or facility-based work.
  • Learn each payer’s facility billing rules for providers who treat patients in hospitals, nursing facilities, or residential programs.
  • Review denials by location and provider together; provider enrollment denials often surface this way.

Specialty notes

Behavioral health and therapy providers treating patients in inpatient, residential, or skilled nursing settings see this most, because many payers treat those services as part of the facility’s payment.

Remark codes that may appear with CO-171

  • N95 (This provider type/provider specialty may not bill this service.): Confirms the provider type or specialty is the issue.
  • M77 (Missing/incomplete/invalid/inappropriate place of service.): The place of service is missing, incomplete, or invalid, which can create a false facility mismatch.
  • CO-170 (Payment is denied when performed/billed by this type of provider.): Denied for this provider type regardless of where the service took place.
  • CO-58 (Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.): Treatment was deemed rendered in an inappropriate or invalid place of service.
  • CO-172 (Payment is adjusted when performed/billed by a provider of this specialty.): Payment adjusted for the provider's specialty, rather than denied.

CO-171 FAQ

How is CO-171 different from CO-170?

CO-170 is about the provider type alone. CO-171 adds the facility: the provider type might be payable in an office but not in, for example, a hospital or skilled nursing setting under that payer's rules.

Where does the payer get the facility type?

From the place of service code in box 24B on professional claims, the service facility information in box 32, and on institutional claims from the type of bill.

Can I fix CO-171 by changing the place of service?

Only if the original place of service was wrong. The POS must reflect where the service actually occurred; changing it just to get paid is a compliance problem.