What does CO-97 mean?
CARC code 97 is a bundling denial. The payer is saying the service you billed is already included in the payment for another service on the same claim. Check the CCI (Correct Coding Initiative) edits to understand the bundling relationship. If the services were truly separate and distinct, you may need to add modifier -59 or the more specific X modifiers (XE, XS, XP, XU) to indicate the services were performed at different encounters, sites, or for different purposes. Review your documentation to ensure it supports the distinct nature of the services. Success rate is approximately 60%.
How to appeal CO-97
Check the RARC code
The RARC (Remittance Advice Remark Code) on your ERA provides specific details about why the claim was denied. This tells you exactly what needs to be fixed.
Correct the identified issue
Fix the specific billing or coding error identified. Verify the correction against payer guidelines before resubmitting.
Resubmit the corrected claim
Resubmit with the appropriate frequency code (7 for replacement, 8 for void/resubmit) along with the corrected information.
Key notes for behavioral health
Bundling issue. Check CCI edits. May need modifier -59 or X modifiers to unbundle.
Related denial codes
Procedure code inconsistent with modifier used or required modifier missing
Diagnosis inconsistent with the procedure
Claim lacks information or has submission/billing error(s)
Procedure/modifier combination not compatible with another already adjudicated
Attachment/documentation required to adjudicate this claim