What does denial code CO-97 mean?

CO-97 means: The payer has already paid for this service as part of another procedure. The benefit is bundled into a previously processed claim, so this separate charge will not be paid again.. There are a few scenarios that exist for denial reason code CO 97. Please review the associated remittance advice remark code (RARC) noted on the remittance advice for your claim and then refer to the specific resources and tips to prevent the denial.

How do I resolve a CO-97 denial?

RARC M144: If a modifier is applicable to the claim, apply the appropriate modifier and resubmit the claim. Submit corrected line(s) only. Resubmitting the entire claim will cause a duplicate claim denial. Applicable modifiers: 54 (pre-and intra-operative), 55 (post-operative management only), 56 (pre-operative only). See full Medicare contractor resolution steps at tryarceum.com.

Can I appeal a CO-97 denial?

Yes. Most CO-97 denials can be appealed within 60-180 days depending on payer. Appeals may succeed if documentation proves the services were distinct, performed at separate sessions, or meet payer-specific criteria for modifier use to override bundling edits. Use our free tool to generate an appeal letter.

CARC Code

97

🟡 Soft Denial

Benefit Included in Another Service

The payer has already paid for this service as part of another procedure. The benefit is bundled into a previously processed claim, so this separate charge will not be paid again.

coding

Resolution: 62%Medium difficulty14-30 days avg

How to resolve this denial

Which payer denied this claim?

▶✓ Pre-action checklist — verify before contacting the payer

Review the full remittance advice (ERA/EOB) for additional RARC codes that explain the denial.
Verify the claim was submitted with correct patient eligibility and benefit information.
Check if this denial applies to a specific line item or the entire claim.

▶More about CO-97 — stats, related codes, appeal template

62%

Recovery Rate

14-30 days

Avg. Resolution

Medium

Difficulty

Common

Frequency

Payer-Specific Notes

How major payers handle CARC 97 by specialty.

Medicare

Follow NCCI edit table strictly; modifier 59 requires distinct procedural service documentation

UnitedHealthcare

UHC has additional payer-specific bundling rules beyond NCCI; check UHC coverage policies

Common 835 Combinations

CARC 97 most often appears with these Group Code + RARC combinations on 835 remittances.

COCO-97This adjustment indicates the provider billed a service separately that is COCO-97+M15This combination indicates the payer has bundled multiple separately-billed COCO-97+N184The service billed has been bundled into payment for another COCO-97+N19This combination indicates payment for the submitted procedure code is bundled COCO-97+N211Note: An informational alert accompanies this denial. This combination COCO-97+N435This combination indicates a service was bundled into a previously paid COCO-97+N95This combination indicates the service was denied because the provider's COCO-97+N56This combination indicates the payer denied the service because an incorrect or

Look up any combination →

Appeal Letter Template

Generic appeal template for CARC 97 denials.

We are appealing the bundling denial (CARC 97) for claim [CLAIM_NUMBER]. The services billed under CPT [CODE_1] and CPT [CODE_2] were distinct and separately identifiable procedures. Per CMS NCCI guidelines, modifier [MODIFIER] applies because [RATIONALE]. Attached is the supporting clinical documentation.

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