EOB denial code · CO group
CO-97: Service Included in Bundle — Meaning & Who Pays
CO-97 means the payer considers the service already bundled into another procedure's payment — for example, an after-surgery X-ray absorbed into the surgery's global package. The charge is real but the payer won't pay it separately. Whether you owe it depends on whether the provider billed it in a way that should have carried a modifier (e.g., -59 for a truly separate service).
What “CO-97” means on your EOB
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. (Use only with Group Code CO)
Who pays? CO — Contractual Obligation
CO (contractual) — the bundled portion is not an additional amount you owe. If the service was truly separate and should have been paid, a corrected claim with the right modifier gets it reprocessed.
What to do next: CO-97 with a modifier attached (like -59, -25, -XE) usually means the claim was coded/billed incorrectly. The correct fix is a corrected claim with the proper modifier showing why the service was separate and not part of an unmodifiable global package. The payer then re-adjudicates the line instead of stacking it onto the bundle.
Why this denial happens
- A follow-up X-ray or lab drawn during a global surgical period was billed without the appropriate modifier.
- Two procedures commonly performed together were billed separately when the code set considers one part of the other.
- An E/M visit on the same date as surgery was billed without modifier -25.
- The provider's software didn't flag the bundled code before submission.
What to do now
- Check the EOB: which service was 'included' and which one paid?
- Ask your provider's coder whether a modifier should have been attached to show the service was separate.
- If yes, submit a corrected claim with the modifier — most bundles reprocess within 30 days.
- If no modifier applies, the service truly is part of the bundle: the provider should have known and should write off any residual patient charge.
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Generate an appeal letter →What does bundled mean on my EOB?
The procedure's payment already includes certain routine services (e.g., same-day X-rays or labs during surgery). The EOB line marks those as included so you don't get a separate bill for them.
Do I owe the CO-97 amount?
If the service truly belongs in the bundle, no — there's no separate allowed amount. If it was a separate service that was incorrectly bundled, the fix is a corrected claim with a modifier, not payment.
What is modifier -59?
-59 is the 'distinct procedural service' modifier. It tells the payer a service was separate and not part of the bundle. When it was wrongly omitted, a corrected claim with -59 usually resolves a CO-97.