CARC 158 Active

PR-158: Service Provided Outside the United States

TL;DR

The patient is responsible for international service charges. Inform the patient, collect the amount, and check for travel or secondary insurance.

Action
Collect from Patient
Who Pays
Patient
Appeal
No
Patient Impact
Direct Financial
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 PR-158 Mean?

PR-158 indicates the patient is financially responsible for services received outside the United States. This is common when the patient elected to seek care abroad and the plan's terms place international services under patient responsibility. The provider should collect from the patient and help them check for supplemental or travel insurance coverage.

CARC 158 appears on your remittance when the payer has determined that the medical service or procedure was provided at a location outside the United States. Most domestic health insurance plans exclude or limit coverage for services rendered internationally, and CARC 158 is the denial code that enforces that exclusion.

The most common trigger in routine billing is a billing error — specifically an incorrect Place of Service code or provider address on the claim that indicates an international location. This can happen with telemedicine services, border-area providers, or when claims processing systems misinterpret a provider's address. Providers in U.S. territories (Puerto Rico, Guam, U.S. Virgin Islands, American Samoa) may also encounter this denial if the payer's system incorrectly classifies the territory as a foreign country.

When the service was genuinely provided outside the U.S., the resolution depends on the group code. Under CO, the provider absorbs the denial — this typically happens when the payer's contract excludes international services as a blanket provision. Under PR, the patient is responsible — common when the patient chose to seek care abroad and the plan assigns that cost to the patient. Some plans include emergency care exceptions for international services, so if the patient received emergency treatment while traveling, check whether the plan has a provision that waives the international exclusion for emergencies. Supplemental travel health insurance may also provide coverage.

Common Causes

Cause Frequency
Patient chose to receive care outside the U.S. The patient elected to seek medical care at an international facility, and their insurance plan holds the patient responsible for services rendered outside the United States Most Common
Travel-related medical services not covered The patient required medical care while traveling abroad, and the plan's terms specify that international medical services are the patient's financial responsibility Common

How to Resolve

Determine whether the denial is due to a billing error or a genuine international service, then either correct the claim or pursue the appropriate resolution based on the group code.

  1. Confirm patient responsibility Verify with the payer that the international service is correctly assigned as patient responsibility under the plan terms.
  2. Notify and collect from the patient Inform the patient that international services are not covered under their plan and provide a statement of the charges they owe.
  3. Check for supplemental coverage Ask the patient whether they have travel health insurance or secondary coverage that may cover international services, and assist with filing if applicable.
Do Not Appeal This Code

This adjustment is correct per the patient's benefit plan. The amount is the patient's financial responsibility. Collect from the patient rather than appealing.

How to Prevent PR-158

General Prevention

Also Filed As

The same CARC 158 may appear with different Group Codes:

CO-158 OA-158

Related Denial Codes

PR-26 — Expenses Incurred Prior to Coverage PR-27 — Expenses Incurred After Coverage Terminated PR-32 — Patient Not Eligible as Dependent PR-33 — Insured Has No Dependent Coverage PR-34 — No Newborn Coverage

Sources

  1. https://www.mdclarity.com/denial-code/158
  2. https://docs.claim.md/docs/claim-adjustment-reason-codes
  3. Codes maintained by X12. Visit x12.org for official definitions.