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97
CO - Contractual ObligationCoding/Billing
Denial Code CO-97: Benefit Included in Another Service
What Does Code 97 Mean?
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. This is a bundling denial.
Group Code CO (Contractual Obligation): The provider has agreed to accept the payer's determination. The patient is generally not responsible for this amount.
Why Does This Happen?
The payer considers this service bundled with another procedure performed on the same date of service.
How to Resolve It
- 1Review NCCI edits and bundling rules
- 2Determine if a modifier (e.g., -59, -XE) is appropriate to unbundle
- 3If services are truly distinct, append the correct modifier and resubmit
- 4Document the distinct nature of each service