CARC 97: The benefit for this service is included in the payment/allowance for another service/procedure that has been adjudicated.
Bundling. The service was rolled into another procedure code and won't be paid separately.
CARC 97 appears on the 835 ERA (Electronic Remittance Advice) that the payer returns after claim adjudication. It explains a reduction, denial, or payment adjustment to your billing team. For your practice, the question is workflow: identify the pattern, route the denial to the right resolution path (rebill, appeal, write-off), and recover what's recoverable without burning RVU time on dead-end fights.
What CARC 97 means
The official X12 description is: “The benefit for this service is included in the payment/allowance for another service/procedure that has been adjudicated.”
In plain language: Bundling. The service was rolled into another procedure code and won't be paid separately.
Common scenarios
- E&M same day as procedure
- Anesthesia bundled with surgery
- Multiple surgical procedures in one session
Practice workflow for CARC X 97
Appeal only when the services are clinically distinct and the bundling is incorrect per CCI (NCCI) edit rules — typically requires using modifier 25 or 59 on resubmission. Often a coding-level fix at the provider.
ApprovalHelp auto-drafts the appeal letter against the right federal appeal-rights regulation (ACA §2719, ERISA §503, NSA §2799A, 42 CFR 422 Subpart M, or 42 CFR 438 Subpart F) for the patient's plan type, the payer's own coverage policy, and the relevant clinical guideline. Drafts route to the clinician for signature in under five minutes.
CARC 97 group codes explained
On the 835 ERA, CARC 97 appears alongside a group code that signals who is financially responsible for the adjustment. CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
Frequently asked questions
What does CARC 97 mean?
The benefit for this service is included in the payment/allowance for another service/procedure that has been adjudicated. In plain language: Bundling. The service was rolled into another procedure code and won't be paid separately.
Is CARC 97 appealable?
Yes — CARC 97 is one of the codes that commonly supports an appeal. Appeal only when the services are clinically distinct and the bundling is incorrect per CCI (NCCI) edit rules — typically requires using modifier 25 or 59 on resubmission. Often a coding-level fix at the provider.
Which group code does CARC 97 appear under?
CARC 97 most often appears under: CO (Contractual Obligation) — Contractual write-off. The provider agreed to the rate. Patient does NOT owe this amount.
When does CARC 97 typically appear on a denial?
Common scenarios: E&M same day as procedure; Anesthesia bundled with surgery; Multiple surgical procedures in one session.
What's the practice workflow for a CARC 97 denial?
Appeal only when the services are clinically distinct and the bundling is incorrect per CCI (NCCI) edit rules — typically requires using modifier 25 or 59 on resubmission. Often a coding-level fix at the provider.
Related resources
Sources
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