Back to All Codes
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
Want the full strategy?
The P2P Playbook covers payer-specific approaches for denial code CO-97 -- plus 15 denial objections with word-for-word responses, what reviewers are actually thinking, and the 60-second prep framework. Written by a medical director who reviewed cases for major payers.
Get The P2P Playbook -- $39