CO-97 Denial Code Explained

CO-97 is a medical billing denial code that indicates the billed service is included in another service or procedure already processed by the insurance payer. This denial commonly occurs when services are considered bundled under a single reimbursement payment.

What Does CO-97 Mean?

The CO-97 denial code means the payer determined the submitted procedure is part of another billed service and does not qualify for separate reimbursement.

This denial is often related to bundled procedures, duplicate billing, or services included within comprehensive payment policies.

Common Reasons for CO-97

• Bundled procedure billing

• Duplicate claim submissions

• Services included in another procedure

• Incorrect modifier usage

• Billing multiple related services separately

• Payer reimbursement policy limitations

How To Fix CO-97

Review the claim and determine whether the denied service should have been billed separately. Verify payer bundling policies and confirm whether a modifier is required to distinguish the service from the primary procedure.

If appropriate documentation supports separate reimbursement, corrected claims or appeals may be submitted with additional details.

Quick Summary

CO-97 indicates the denied service is considered part of another reimbursed procedure. Most CO-97 denials are related to bundled billing rules or payer reimbursement policies.