What CO-97 means
The benefit for this service is considered included in the payment for another procedure performed the same day. Often correct — but frequently a missing-modifier issue where a distinct, separately payable service was bundled in error.
Common causes
- NCCI edits bundled two codes billed together
- Modifier 25 or 59 (distinct service) was missing or omitted
- The second service was genuinely separate and identifiable
How to appeal CO-97
If the services were genuinely distinct, append the appropriate modifier (25 or 59/X{EPSU}) with documentation showing the separate, identifiable service, and cite the relevant NCCI guidance in the appeal.
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