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.
Retrieved 2026-07-18.
Do not let this happen again
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DenialPath 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.