CO-97 (Service Included in Another Service)
Contractual Obligation 97 — the benefit for this service is included in the payment for another service.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Denials & Appeals
- Primary sources
- 2
- Workspace handoff
- denial workbench →
Where this comes up
This is denial-workbench territory. A remit posts with a CARC/RARC, the biller decides whether to rebill, appeal, or write off, and the appeal packet has to cite the chart, the order, and the payer's own policy language. Recurring patterns trace back to an upstream workflow gap.
Full definition
What it is in practice
CO-97 is the bundling denial — typically a NCCI edit. The fix is usually modifier 59, X{EPSU}, or 25 — if clinically supported.
How it shows up in your practice
Train coders to recognize CO-97 and apply the right modifier (or write off if the bundling is correct).
Sources
- CMS — CARChttps://x12.org/codes/claim-adjustment-reason-codes
- CMS — NCCIhttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
Resolve CO-97 bundling denials in the Denial Workbench
Open denial workbench →Related terms
- Denials & AppealsCARC (Claim Adjustment Reason Code)X12-maintained codes communicating why a claim or service line was paid differently than billed.
- BillingNCCI EditsThe CMS National Correct Coding Initiative edits that prevent improper payment when incorrect code combinations are reported.
- BillingModifier 59CPT modifier identifying a distinct procedural service that is not normally reported together but is appropriate under the circumstances.
- BillingX{EPSU} ModifiersCMS modifiers XE, XS, XP, and XU created to provide a more specific alternative to modifier 59 for indicating distinct procedural services.
- BillingModifier 25CPT modifier indicating that a significant, separately identifiable E/M service was performed by the same provider on the same day as another procedure or service.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryCARC (Claim Adjustment Reason Code)X12-maintained codes communicating why a claim or service line was paid differently than billed.
- GlossaryModifier 59CPT modifier identifying a distinct procedural service that is not normally reported together but is appropriate under the circumstances.
- GlossaryNCCI EditsThe CMS National Correct Coding Initiative edits that prevent improper payment when incorrect code combinations are reported.
- BillingModifier 25: When to Use It and Common MistakesWhen to use modifier -25, when to skip it, and the common mistakes that trigger audits and denials.
- GlossaryModifier 25CPT modifier indicating that a significant, separately identifiable E/M service was performed by the same provider on the same day as another procedure or service.
- GlossaryX{EPSU} ModifiersCMS modifiers XE, XS, XP, and XU created to provide a more specific alternative to modifier 59 for indicating distinct procedural services.
- GlossaryAppeal LetterThe written request to a payer to reconsider a denied or partially-paid claim.
- RegulationNCCI Modifier Overrides (Modifier 59 and X{EPSU})Modifier 59 (and its more specific subsets XE, XS, XP, XU) is the principal mechanism for overriding a PTP edit when a procedure is distinct or independent from another performed on the same day.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.