CARC 97
Bundled into another service
The payer considers this service part of something else it has already paid for.
Why you actually get this
- The service genuinely is a component of a more comprehensive procedure billed the same day.
- A distinct service was performed but billed without a modifier separating it.
- The service falls inside a global period following a procedure.
- The payer's bundling edits are more aggressive than the code set implies.
How to check whether it’s correct
- 01Establish what the payer says this was bundled into, and whether that service was genuinely comprehensive of it.
- 02Check whether a distinct-service modifier applies — different session, different site, different encounter.
- 03Confirm whether a global period was running on the date of service.
Sometimes worth appealing
Turns on whether the service was genuinely separate. Where it was — a different site, a different session — a modifier and documentation usually recover it. Where it is a true component, appealing wastes time better spent elsewhere. A pattern of these against one payer is worth raising with your contract manager rather than appealing claim by claim.
Often arrives with
Seeing a lot of these?
A single denial is a claim to work. A pattern of the same denial is a process to fix, and the two need completely different responses. A free panel reads ninety days of your claims data and shows which codes actually recur for you.
Claim Adjustment Reason Codes are maintained by X12 as External Code List 139. The official description of this code is theirs and is not reproduced here. Check the authoritative list for current wording and status.