What CO-97 means
The payer bundled this service into another one already paid.
The CO group code means this amount is a contractual obligation: under most contracts you cannot bill it to the patient.
Common causes
- Code pair bundled under NCCI or payer edits
- Missing modifier for a distinct service
How to fix it
- Check NCCI edits for the code pair
- If the service was truly separate and documented, add the right modifier (such as 59 or X{EPSU}) and resubmit
Check the remark code (RARC) that came with the denial and the payer's own policy, since rules vary by payer and plan. This is a plain-English summary written by GetMax; the official code text is published by X12 at x12.org/codes.
Prevent it next time
Most denials are caused before the claim is sent. See 12 ways to reduce claim denials, or let our denial management team work them for you.