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CO-P20 Denial Code: Not Paid Under P&C Facility Schedule

CO-P20 means the service isn't payable under the jurisdiction's allowed outpatient facility fee schedule. It applies to property and casualty facility bills, such as hospital outpatient or ambulatory surgery center claims under workers' comp or auto coverage.

Quick facts

Code
CO-P20 (CARC P20)
Status
Active In use since November 1, 2013.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • CO (Contractual Obligation): The usual group. The facility absorbs the amount, and state rules generally bar billing the claimant.
Official description
Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What CO-P20 means

CARC P20 says service not paid under jurisdiction allowed outpatient facility fee schedule. X12 limits it to property and casualty claims. It replaced deactivated CARC W9.

Many states have separate workers’ comp or auto fee schedules for outpatient facilities, such as hospital outpatient departments and ambulatory surgery centers. These schedules specify which services the facility can be paid for and how. When a facility bills a service that isn’t payable under that schedule, the payer denies the line with CO-P20.

This mainly affects institutional billing. The physician’s professional bill for the same service is handled under the professional fee schedule and different codes.

Common causes

  • Procedure not on the state’s approved list for ambulatory surgery centers or hospital outpatient payment.
  • Service packaged into another facility payment under the state’s method.
  • Wrong bill type or revenue code, so the service was priced under the wrong schedule.
  • Service should be billed by the professional, not the facility, under state rules.
  • Wrong schedule year applied.

How to fix it

  1. Check the state’s outpatient facility schedule for the date of service and setting.
  2. Confirm bill type and revenue coding match the setting.
  3. If coding was wrong, correct and resubmit under the state’s rules.
  4. If the service is payable, request reconsideration citing the schedule.
  5. If it isn’t payable in that setting, accept the adjustment and review whether prior authorization for a different setting was needed.

How to prevent problems

  • Verify facility payability for workers’ comp and auto cases before scheduling procedures.
  • Get carrier approval for procedures performed in outpatient facilities.
  • Keep state facility schedules current in your billing system.

Specialty notes

Ambulatory surgery centers treating injured workers should confirm that each planned procedure is on the state’s list of payable ASC procedures before scheduling.

Remark codes that may appear with CO-P20

  • N676 (Service does not qualify for payment under the Outpatient Facility Fee Schedule.): The service doesn't qualify for payment under the outpatient facility fee schedule.
  • N673 (Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.): Reimbursement was calculated based on an outpatient per diem or factor and fee schedule amount.
  • CO-W9Deactivated (Service not paid under jurisdiction allowed outpatient facility fee schedule.): The deactivated code that CARC P20 replaced.
  • CO-P12 (Workers' compensation jurisdictional fee schedule adjustment.): A workers' comp jurisdictional fee schedule adjustment.
  • CO-P19 (Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due.): Zero relative value in the jurisdiction fee schedule.
  • CO-58 (Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.): Service rendered in an inappropriate place of service, used outside P&C.

CO-P20 FAQ

Why would an outpatient facility service not be paid?

State outpatient facility schedules often list which procedures a hospital outpatient department or surgery center may be paid for. Services not on the list, or packaged into another service, may not be separately payable.

Can the facility bill under a different schedule?

Sometimes. Some states pay certain services under a different schedule, such as the professional or inpatient schedule. Check the state's rules.

How do I dispute CO-P20?

If the service is on the state's allowed list for that setting, request reconsideration with the schedule citation, then use the state's dispute process.

Is CO-P20 used for professional bills?

It's aimed at facility bills under P&C outpatient facility fee schedules. Professional services use other P&C codes.

Can I bill the injured person for a CO-P20 line?

Generally not for services related to an accepted workers' comp or no-fault claim. State rules usually limit the provider to what the fee schedules allow.

Does CO-P20 mean the procedure shouldn't have been done?

Not necessarily. It means the facility portion isn't payable under that schedule in that setting. The physician's professional service may still be paid separately.