CARC 97: Included in another service (bundled)
The payer considers this service part of another service paid on the same claim or day, so it is not paid separately.
Group code context
Usually sent with group code CO (contractual obligation): under your contract you cannot bill the patient for this amount.
Common causes
- NCCI edit bundles the two codes
- Missing modifier 25 or 59 when the services were separate
- Supply or minor service included in the main procedure
Step-by-step fix
- Check the code pair against NCCI or the payer's bundling edits
- If the services were truly separate and documented, add the right modifier and send a corrected claim
- If not, accept the bundling
Appeal guidance
Appeal when separate, documented services were bundled even with the right modifier.
When not to appeal
Do not appeal correct bundling.
Prevention checklist
- Run NCCI edits in your scrubber
- Train coders on modifier 59 and X modifiers
Related codes
CARC 4: Modifier missing or inconsistent with the procedure code
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Source and review
Official source ↗Last checked: 2026-10-05
Reviewed by: PracticeVendors editorial team
Educational reference. Confirm payer instructions and applicable contracts before taking action.