Charge is bundled — payment included in another service
The insurer says this line item is already paid for as part of another procedure on the same day. It should not be billed separately.
Could be the insurer or the provider — start with whoever issued the code
Cite CO-97 and argue the charge is either (a) correctly bundled and should be written off, or (b) meets NCCI modifier criteria (25/59) for separate payment. Request the provider either drop the charge or resubmit with the correct modifier.
- Request a fully itemized bill from the provider — not the summary statement.
- Match every line on the itemized bill to a line on your EOB. Charges that appear on one and not the other are the usual source of errors.
- Ask the insurer, in writing, for the specific plan provision behind the code.
- Note the appeal deadline printed on your EOB and diary it — missing it forfeits the appeal.
What does denial code CO-97 mean?
CO-97 means "Charge is bundled — payment included in another service". The insurer says this line item is already paid for as part of another procedure on the same day. It should not be billed separately.
Do I have to pay a CO-97 charge?
Not necessarily. CO-97 is appealable in most plans. Ask for the written policy language behind the decision before paying, and file an internal appeal within your plan's deadline (often 180 days from the EOB date).
How do I appeal a CO-97 denial?
Cite CO-97 and argue the charge is either (a) correctly bundled and should be written off, or (b) meets NCCI modifier criteria (25/59) for separate payment. Request the provider either drop the charge or resubmit with the correct modifier.
Where do I send a CO-97 appeal?
Could be the insurer or the provider — start with whoever issued the code. Use the appeals address printed on your EOB or the provider's statement, send it in writing, and keep a dated copy. If an internal appeal fails, most states also offer an independent external review.
How long do I have to appeal CO-97?
Most commercial plans allow 180 days from the date on the Explanation of Benefits for an internal appeal; Medicare and some employer plans differ. Check the appeal-rights section of your EOB and file early — missed deadlines are the most common reason appeals fail.
Let BillCheck write the CO-97 appeal for you
Upload your EOB and itemized bill. We decode every code, flag the errors, and draft a ready-to-send appeal letter addressed to the right office.
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BillCheck provides informational analysis only and is not legal, medical, or financial advice. Verify all details before submitting any correspondence to insurers or providers.