CO-97
Payment included in the allowance for another service already adjudicated
What This Code Means
The payer considers this service bundled into, or a component of, another procedure already paid on the same claim or date of service.
Common Causes
- Missing modifier 25 or 59 to indicate a separately identifiable service
- NCCI edit pair billed without an applicable modifier
- Global surgical package includes this service
How to Resolve or Appeal
- Check whether an NCCI-associated modifier applies and was omitted
- Confirm the service isn't genuinely part of a global package
- Resubmit with the correct modifier if separately identifiable
- Appeal with documentation if bundling was applied incorrectly
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.