CO-97: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
This service is considered bundled into another procedure billed the same day, or into a global period, so the payer will not pay for it separately. Common with global surgical periods, E/M visits billed alongside a minor procedure, or add-on codes billed without their primary code.
What the group code means
- CO
- Contractual Obligation. The provider is responsible and the amount cannot be billed to the patient.
Why it fires
- The billed code is a component of, or incidental to, another code paid on the same claim
- A global surgery period covers a related E/M or procedure billed within the post-op window
- An add-on code was billed without its required primary/base code, or an NCCI bundling edit applies
Corrective actions, ranked
- 1
Check NCCI edits
Run the code pair through the National Correct Coding Initiative edits to see if a modifier (25, 59, XE/XS/XP/XU) is appropriate and supported by documentation.
- 2
Confirm the global period
If a surgical global period applies, verify whether the service is truly unrelated and eligible for modifier 24 or 79.
- 3
Rebill with a modifier if supported
If documentation supports a separately identifiable service, append the correct modifier and resubmit rather than appeal blind.
Is it worth appealing
Worth appealing with documentation when the service is clearly separately identifiable, such as a different diagnosis or a service unrelated to the global period, but was denied without a modifier on file.
Modifiers named in these corrective actions
The corrective actions for CO-97 point at these modifiers. Check when each one is appropriate before you append it.
- Modifier 59Distinct procedural service
- Modifier XESeparate encounter
- Modifier XSSeparate structure
- Modifier XPSeparate practitioner
- Modifier XUUnusual non-overlapping service
- Modifier 25Significant, separately identifiable evaluation and management service
- Modifier 24Unrelated evaluation and management service by the same physician during a postoperative period
- Modifier 79Unrelated procedure or service by the same physician during the postoperative period
Other denial codes to check
Codes that share a remark code with this one, or that are reported under the same group code.
- CO-45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.
- CO-16Claim/service lacks information or has submission/billing error(s).
- CO-11The diagnosis is inconsistent with the procedure.
- OA-18Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
- CO-29The time limit for filing has expired.
- PR-151Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Retrieved 2026-07-18.
Do not let this happen again
Scrub the claim against NCCI PTP and MUE edits before you submit, free and in your browser.
Denial7 provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.