CARC · CO group

CO-97

Benefit for this service is included in the payment for another service already adjudicated

Contractual obligation; provider write-off unless appealed

What it means

The payer bundled this line into another line it already paid.

Likely cause

Add-on codes billed alongside a primary service without correct modifiers, or NCCI edit pairs submitted together.

How to fix it

Run the code pair through NCCI edits. If the services were distinct, resubmit with modifier 25 or 59 and documentation supporting separateness.

Revenue impact

Very often legitimately appealable. This is a top-three source of recoverable dollars.

• bundling
• NCCI
• appeal