CO-97 Denial Code: Included in Payment for Another Service (Bundled)
The CO-97 denial code means the benefit for this service is already included in the payment for another service that has been adjudicated - in short, the line is bundled. Typical examples are services billed during a surgical global period and procedure combinations where one code's payment includes the other's work. The decision to make is whether the bundling is correct (write-off) or whether the service was truly separate and needs a modifier and appeal.
Common Causes
- An E/M visit or routine post-op care billed within another procedure's global surgical period
- A component service billed alongside a comprehensive code that includes it
- Services that payer edits (including NCCI-based logic) treat as part of the primary procedure billed the same day
- A separately identifiable service performed the same day but billed without the modifier that communicates that (25 for E/M, 59/X{EPSU} or 79 as appropriate)
- Duplicate-ish billing: two providers in the same group billing overlapping care in a global period
How to Fix CO-97
- Identify what the service bundled into - the remit and payer portal show the primary adjudicated service
- If the service was routine post-op or a true component of the primary procedure, the denial is correct: post the write-off
- If the documentation supports a distinct service (unrelated E/M in a global period, different site or session), add the appropriate modifier (24, 25, 59/X, 79) and resubmit or appeal with notes
- Check global period lengths (0, 10, or 90 days) before billing E/M visits after surgery
- Run planned code pairs through an NCCI edit checker before submission to know which combinations need modifiers or cannot be billed together at all
Frequently Asked Questions
CO-97 means payment for this service is included in the allowance for another service already processed - the line is bundled. Common scenarios are visits during a surgical global period and component services billed with a comprehensive procedure.
Only if the service was genuinely separate: an unrelated E/M during a global period (modifier 24), a significant separately identifiable E/M same day as a procedure (modifier 25), or a distinct procedure (59/X modifiers). Append the modifier the documentation supports and resubmit or appeal. If the service was truly included, write it off.
Both involve bundling logic. CO-97 says the payment is included in another adjudicated service (global periods, component services). CO-236 specifically cites a National Correct Coding Initiative (NCCI) procedure-to-procedure edit for codes billed the same day.
Related Denial Codes
Related Resources
Claim adjustment reason codes and remittance advice remark codes are standardized code sets maintained by X12. The explanations on this page are written in our own words for educational purposes, based on public CMS and Medicare contractor documentation. Payer policies vary - always confirm handling with the specific payer's guidance and your contracts.