How do I resolve a CO-97 denial?

Identify which 'parent' service caused the bundle by checking the NCCI PTP (Procedure-to-Procedure) edit table at cms.gov. Determine if a modifier can unbundle the services: Modifier 59 (distinct procedural service), XE, XS, XP, or XU may apply if the services were truly separate. Review the clinical documentation to confirm both services were distinct and medically necessary. If a valid modifier applies, resubmit with the appropriate modifier on the bundled code. If no modifier applies, write off the bundled service — billing the patient is prohibited for services bundled by NCCI edits.

Can I appeal a CO-97 denial?

Yes. CO-97 denials are typically appealable with a 45% success rate. Resolution difficulty is Medium and typically takes 14-21 days.

835 Denial Combination

CO-97

Contractual Obligation · Service-Line Level Adjustment

What This Combination Means

The payment for this service is included in the payment for another service rendered on the same date. The billed procedure is considered bundled by the payer's payment rules — it cannot be paid separately. This is commonly triggered by NCCI (National Correct Coding Initiative) edits or payer-specific bundling rules.

45%

Appeal Success

14-21 days

Avg. Resolution

Medium

Difficulty

Yes

Appealable

Step-by-Step Resolution

Steps tailored specifically to this CO-97 combination — not generic advice.

1
Identify which 'parent' service caused the bundle by checking the NCCI PTP (Procedure-to-Procedure) edit table at cms.gov.
2
Determine if a modifier can unbundle the services: Modifier 59 (distinct procedural service), XE, XS, XP, or XU may apply if the services were truly separate.
3
Review the clinical documentation to confirm both services were distinct and medically necessary.
4
If a valid modifier applies, resubmit with the appropriate modifier on the bundled code.
5
If no modifier applies, write off the bundled service — billing the patient is prohibited for services bundled by NCCI edits.

Specialty Context

How CO-97 typically presents across different practice types.

Dental

Common in dental when a comprehensive exam and bitewing X-rays are billed together — some payers bundle the X-ray reading fee into the exam code.

Medical

NCCI bundling is extensive. Common examples: 99213 bundled with 99000 (handling fee), or a minor surgical procedure bundled with the E&M on the same day. Check the NCCI PTP edit table.

Behavioral Health

Psychotherapy add-on codes (90833, 90836) are often bundled with the E&M unless the two services are clearly documented as separate and distinct.

Individual Code References

View the standalone definition for each code in this combination.

CARC 97

Decode every 835 combination automatically

Arceum Pro reads your ERA files and surfaces the combined interpretation + recovery steps for every denial — no manual lookups.

Join the Waitlist →

← Back to Combo Lookup Browse All Codes →