CO-97 Denial Code Explained

CO-97 is a medical billing denial code that indicates the service billed is included in the payment for another procedure or service. This denial commonly occurs when the insurance payer considers the service bundled and not separately reimbursable.

What Does CO-97 Mean?

The CO-97 denial code means the benefit for the service is included in the payment or allowance for another service that has already been processed.

This denial is commonly associated with payer bundling rules, coding edits, and services that are not eligible for separate reimbursement.

Common Reasons for CO-97

• Service bundled into another procedure

• Missing modifier on the claim

• Incorrect unbundling of services

• Global surgical package rules

• Duplicate or overlapping services

• National Correct Coding Initiative (NCCI) edits

How To Fix CO-97

Review the claim and determine whether the denied service is bundled into another procedure. Verify that all coding is correct and confirm whether a modifier such as Modifier 25 or Modifier 59 is required. If documentation supports separate reimbursement, correct the claim and resubmit it to the payer.

If the denial involves an office visit code, reviewing the CPT code requirements may help identify billing issues. Related CPT resources can be found on CPTCodeGuide.com

If a modifier may be required, review Modifier 25 and Modifier 59 guidance on ModifierLookup.com.

Frequently Asked Questions

What does CO-97 mean?

CO-97 means the payer considers the service included in the payment for another procedure and will not reimburse it separately.

Can CO-97 be appealed?

Yes. If documentation supports that the service was separate and distinct from the primary procedure, an appeal or corrected claim may be appropriate.

What modifiers are commonly associated with CO-97?

Modifier 25 and Modifier 59 are the modifiers most commonly associated with CO-97 denials.

Is CO-97 a common denial?

Yes. CO-97 is one of the most common denial codes related to bundling and coding edits.

Related Denial Codes

You may also encounter:

• CO-4 — Procedure inconsistent with modifier

• CO-16 — Missing or incomplete claim information

• CO-45 — Charge exceeds fee schedule allowance

• CO-109 — Claim not covered by this payer

Quick Summary

CO-97 indicates the billed service is included in the payment for another procedure. Most denials are caused by bundling rules, coding edits, or missing modifiers.