97Denial Code (CARC)Active
CO 97 Denial Code - Bundle Payment Explained
Code 97 indicates that the service you billed has already been paid for because its cost is bundled into the payment for another service. This means that the payer considers this service to be part of another procedure that has already been reimbursed.
Who Pays: Group Code Liability
With code 97, the group code is typically CO, meaning the provider must write off the amount and cannot bill the patient. This is because the service is considered covered under a different payment.
Why Claims Get Code 97
- Billing for components of a procedure already reimbursed as a global service.
- Submitting a claim for a service that is part of a package or bundle already adjudicated.
- Duplicate billing of a service included in a previously adjudicated claim.
- Misunderstanding payer bundling rules leading to separate charges for included services.
How to Fix & Resubmit
- Review the remittance advice to identify which previously adjudicated service includes the denied service.
- Check the Healthcare Policy Identification Segment in the 835 for details on bundled services.
- Verify with the payer if the service was correctly identified as included in another payment.
- If the bundling is accurate, write off the charge as contractual obligation; otherwise, prepare documentation for an appeal.
- Submit an appeal if the service was improperly bundled, providing evidence that it should be separately reimbursed.
Corrected Claim or Appeal?
Submit a corrected claim only if the initial claim was coded incorrectly. Appeal if you believe the service was wrongly bundled with another procedure. If the bundling is legitimate, no action beyond the write-off is needed.
Preventing Future 97 Denials
- Ensure understanding of payer-specific bundling policies and guidelines.
- Use coding resources or software to verify which services are typically bundled before claim submission.
- Train billing staff to recognize common bundling scenarios and avoid separate billing for included services.
- Regularly review payer policy updates to stay informed about changes in bundling rules.