835 Denial Combination

CO-97+N390

CO

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

HCPCS billed is included in payment/allowance for another service/procedure that was already adjudicated

N/A

Appeal Success

7-14 days

Avg. Resolution

Medium

Difficulty

No

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-97+N390 combination — not generic advice.

  1. 1

    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.

Specialty Context

How CO-97+N390 typically presents across different practice types.

Dental

Medical

Behavioral Health

Individual Code References

View the standalone definition for each code in this combination.

Medicare Contractor Guidance for CARC 97

FCSO + Noridian

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 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.

CMS IOM, Pub. Medicare Claims Processing Manual 100-04, Chapter 12, section 20.3CMS IOM, Pub. 100-04 Claims Processing Manual, Chapter 12, section 40CMS IOM, Pub. 100-04 Claims Processing Manual, Chapter 10First Coast fee schedule lookup toolSPOTHHA documentation reportsNoridian Medicare PortalNMPIVRSame or Similar

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