CO-97+M80

Step-by-Step Resolution

Steps tailored specifically to this CO-97+M80 combination — not generic advice.

1. 1

   Review claim submitted for similar items provided on same date of service listed in Local Coverage Determination (LCD), LCD Policy Article and either adjust amounts because of supplier liable or appeal claim with documentation to support medical need

2. 2

   A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal

Specialty Context

How CO-97+M80 typically presents across different practice types.

Individual Code References

View the standalone definition for each code in this combination.

How to Prevent CARC 97 Denials

• ✓

  RARC M15 (Bundled services): If the procedure code has a 'b' status on the Medicare Physician Fee Schedule (MPFS) database, the service should not be billed to Medicare. Check your most frequently billed procedure codes on the First Coast fee schedule lookup tool — if status is 'b', do not bill Medicare.

• ✓

  RARC M144 (Pre/post-operative care): If billing for split care, coordinate split-care billing activities with other provider(s) involved in the patient's care, and ensure the surgical code is billed before the services for post-operative care are billed.

• ✓

  RARC N70 (Consolidated billing): Before providing services to a Medicare beneficiary, determine if a home health episode exists. Ask the beneficiary if they are receiving home health services under a home health plan of care. Always check beneficiary eligibility prior to submitting your claim via SPOT.