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Denial Code CARC 97: The benefit for this service is included in another service already adjudicated (bundling)

CARC 97 means: the benefit for this service is included in another service already adjudicated (bundling). Here's what it means in plain English, why it happens, and how it's worked toward payment.

Why you get a CARC 97 denial

• NCCI bundled this code into another procedure billed the same day.
• A distinct service wasn't flagged with the appropriate modifier.
• The edit is a true column-0 (mutually exclusive) bundle that isn't separately payable.

How to fix or appeal CARC 97

1. Identify the NCCI edit pair behind the bundle.
2. If the services were distinct and documented, resubmit with the correct modifier (e.g., 59/X{EPSU}, 25).
3. If it's a mutually exclusive edit, the component isn't separately payable — confirm the primary paid at contract.

Recoverable when a distinct service was wrongly bundled and documentation supports a modifier; otherwise it's a legitimate bundle.

CARC 97 — FAQ

How do I fix a CARC 97 bundling denial?

Check the NCCI edit pair. If the two services were genuinely separate and the record supports it, resubmit with the appropriate modifier. If they're mutually exclusive, the bundled code isn't separately payable.

When can I use a modifier on CARC 97?

Only when documentation supports a distinct procedural service — for example modifier 59 or the X{EPSU} subset. Modifiers should reflect the record, never be added just to unbundle.