EOB denial code CO-97: what it means

What it means

This service is bundled into the payment for another service that was already processed, so it is not paid separately.

Contractual Obligation — an adjustment the provider agreed to by contract. The patient is generally not billed for CO amounts.

Official X12 description

“The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated”

Typical cause

Bundling/global-payment rules — the insurer considers this part of another procedure that was already reimbursed.

What to do next

1. 1This is generally a provider billing matter, not a patient-owed amount.
2. 2If the services were genuinely separate, your provider can appeal with documentation (and a modifier if appropriate).