DENIAL CODE · CO-97

CO-97: Bundled into Another Service

CO-97 means the payer applied a bundling edit and folded one procedure into another, paying only the primary code even though both services were performed.

Official (X12/WPC): "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated."
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Why payers issue CO-97

  • Two codes hit an NCCI edit pair and the second was denied as inclusive
  • A distinct-service modifier (59, XS, XU) was missing or unsupported
  • The procedures looked like the same session when they were separate
  • A global-period E/M was bundled without modifier 24/25/57

Is it recoverable? Recoverable when the second service was genuinely separate — the appeal proves distinctness with the right modifier and documentation.

How to appeal a Bundling / NCCI Edits denial →Recover Bundling That Reduced Payment →

Common questions

What does CO-97 mean?

CO-97 means the payer applied a bundling edit and folded one procedure into another, paying only the primary code even though both services were performed. The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

How do I appeal or fix a CO-97 denial?

Recoverable when the second service was genuinely separate — the appeal proves distinctness with the right modifier and documentation. Common causes: two codes hit an NCCI edit pair and the second was denied as inclusive; a distinct-service modifier (59, XS, XU) was missing or unsupported; the procedures looked like the same session when they were separate; a global-period E/M was bundled without modifier 24/25/57.

Is a CO-97 denial worth appealing?

Recoverable when the second service was genuinely separate — the appeal proves distinctness with the right modifier and documentation. You only pay on what's actually recovered, so there's no cost to working the ones that are winnable.

Other denial codes
CO-197 · Precertification / Authorization Absent →CO-50 · Not Medically Necessary →CO-16 · Missing or Invalid Information →CO-45 · Charge Exceeds Fee Schedule →CO-29 · Timely Filing Expired →CO-96 · Non-Covered Charge →OA-18 · Duplicate Claim →OA-22 · Coordination of Benefits →CO-11 · Diagnosis Inconsistent with Procedure →CO-151 · Too Many Services (Frequency/MUE) →CO-B7 · Provider Not Eligible →CO-27 · Coverage Terminated →CO-204 · Not Covered Under Current Plan →CO-109 · Not Covered by This Payer →CO-119 · Benefit Maximum Reached →CO-4 · Modifier Inconsistent or Missing →CO-15 · Authorization Number Missing or Invalid →OA-23 · Prior Payer Adjudication Impact →CO-24 · Charges Covered Under Capitation →CO-26 · Expenses Incurred Prior to Coverage →CO-54 · Assistant Surgeon Not Covered →CO-55 · Experimental / Investigational →CO-58 · Inappropriate Place of Service →CO-59 · Multiple/Concurrent Procedure Reduction →CO-107 · Related/Qualifying Claim Not Identified →CO-167 · Diagnosis Not Covered →CO-170 · Denied for This Provider Type →CO-181 · Procedure Code Invalid on Date of Service →CO-182 · Procedure Modifier Invalid on Date of Service →CO-183 · Referring Provider Not Eligible to Refer →CO-185 · Rendering Provider Not Eligible →CO-198 · Precertification / Authorization Exceeded →CO-226 · Requested Provider Information Not Provided →CO-231 · Mutually Exclusive Procedures →CO-234 · Procedure Not Paid Separately →CO-236 · Procedure/Modifier Combination Not Compatible →CO-242 · Out-of-Network / Non-Network Provider →CO-252 · Documentation Required to Adjudicate →CO-253 · Sequestration Reduction →CO-256 · Not Payable Per Managed-Care Contract →CO-288 · Referral Absent →CO-B15 · Qualifying Service Not Received →CO-B16 · New Patient Qualifications Not Met →CO-A1 · Claim/Service Denied (Remark Required) →

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