CO-97 Denial Code: Payment included in another service's allowance (bundling)
The payer bundled this service into another procedure paid the same day, per NCCI edits or their own policy — sometimes correctly, often not.
Why it happens
- NCCI procedure-to-procedure edit pairs the codes and no modifier was applied
- A distinct, separately billable service was performed but not flagged (modifier 59/X-series, 25)
- Payer bundles more aggressively than NCCI (plan-specific policy)
- True bundling — the service really is included (e.g., routine supplies with a procedure)
How to fix it, step by step
- Check the NCCI edit for the code pair — does an allowed modifier exist?
- If the services were genuinely distinct (different site, session, or injury): resubmit with the correct modifier and documentation
- If the payer bundles beyond NCCI: appeal citing NCCI as the standard and demand the plan policy in writing
- If truly bundled: write it off — and stop billing it separately
Is it worth working?
Moderate-to-high where a modifier legitimately applies; the key is documentation showing the services were distinct.
Moderate-to-high where a modifier legitimately applies; the key is documentation showing the services were distinct.
How much is your practice writing off to denials like this?
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Get the free denial auditMore codes: the Claimmender denial-code library.