CARC Code
97
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
62%
Recovery Rate
14-30 days
Avg. Resolution
Medium
Difficulty
Common
Frequency
Recommended Action
Review NCCI bundling edits and appeal with appropriate modifier if unbundling is justified
Step-by-Step Resolution
- 1
Identify the 'parent' procedure that includes the bundled service in its payment
- 2
Look up the NCCI bundling pair in the CMS NCCI edit table
- 3
Determine if an appropriate unbundling modifier (59, XS, XE, XP, XU) applies
- 4
If modifier is appropriate, resubmit with the modifier and a clear documentation note
- 5
If no modifier applies, write off the bundled service as a contractual adjustment
- 6
Train clinical staff on documentation requirements for separately reportable services
Common Remark Codes (RARC)
These RARC codes often appear alongside CARC 97 on remittance advice.
Payer-Specific Notes
How major payers handle CARC 97 in practice.
Delta Dental
Buildup (D2950) bundled with crown procedures by many payers; document separately
MetLife Dental
Exam fees bundled with other same-day procedures; check plan guidelines
Common 835 Combinations
CARC 97 most often appears with these Group Code + RARC combinations on 835 remittances.
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