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 is the code your insurance company used to explain why your claim was reduced, denied, or paid less than expected. It appears on your Explanation of Benefits (EOB) — the statement your plan sends after a claim is processed. Here's what it means for you and what you can do about it.
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
What to do next 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.
DenialHelp helps organize a source-linked draft from the denial notice and confirmed case facts. The patient and treating clinician must verify the governing review rule, current payer policy, clinical sources, attachments, destination, and deadline.
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.
How do I appeal 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
Appeal a CARC 97 denial
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