Included in the payment for another service (bundled)
The payer says this service is part of another service billed on the same day, so it is not paid separately.
CO = Contractual Obligation. The provider owes the difference. The patient cannot be billed for this amount. The same reason code can appear with a different group code; the group decides who may be billed.
Usual causes
- NCCI bundling edits (for example an E/M visit with a minor procedure without modifier 25, or supplies included in the procedure).
- Global surgical package: post-operative visits inside the global period (M144).
- Lab panel components billed separately.
The fix
Check the NCCI edit for the pair. If the second service was separate and distinct and the documentation shows it, add the correct modifier (25, 59 or an X modifier) and send a corrected claim. If it is truly bundled, write it off and stop billing the component.
Appeal or corrected claim?
Corrected claim with the modifier when the service was distinct; otherwise a contractual write-off. Appeal with records only if the modifier was already there and the payer still bundled it.
Deadline to watch
Timely filing limit.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
Often seen together
Bundled: the services billed are components of one procedure. Add modifier 59 or an X modifier only when the services were truly separate and documented.
CO-97 in short
What does CO-97 mean?
The payer says this service is part of another service billed on the same day, so it is not paid separately. The official X12 text reads: "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."
What usually causes a CO-97 denial?
NCCI bundling edits (for example an E/M visit with a minor procedure without modifier 25, or supplies included in the procedure). Global surgical package: post-operative visits inside the global period (M144). Lab panel components billed separately.
How do I fix CO-97?
Check the NCCI edit for the pair. If the second service was separate and distinct and the documentation shows it, add the correct modifier (25, 59 or an X modifier) and send a corrected claim. If it is truly bundled, write it off and stop billing the component.
Should I appeal CO-97 or send a corrected claim?
Correct or appeal (see note). Corrected claim with the modifier when the service was distinct; otherwise a contractual write-off. Appeal with records only if the modifier was already there and the payer still bundled it.
What deadline applies to CO-97?
Timely filing limit.