Denial Codes / CARC 97
Denial Code CARC 97: Service Bundled Into Another Payment
CARC 97 means the payer bundled this service into the payment for another procedure billed the same day. It is appealable when the service was genuinely separate and distinct, because bundling edits over-apply and the correct modifier plus documentation can unbundle a legitimately separate service.
What this denial means
The payer applied a bundling edit and treated this procedure as part of another one already paid, so it pays nothing additional for it.
Why it happens
Bundling edits are broad and frequently catch services that were actually separate and distinct. The claim may have lacked the modifier that signals a distinct procedural service, or the documentation that shows the two procedures addressed different sites or problems.
The appeal angle that works
If the service was genuinely separate, appeal with the distinct-procedural-service modifier and documentation establishing that it addressed a different site, tooth, or clinical problem than the procedure it was bundled into. The appeal has to show the two were not the same work, which is exactly what the chart usually shows.
Questions
Can a bundled-service denial be unbundled on appeal?
Yes, when the service was genuinely separate and distinct. Appeal with the distinct-procedural-service modifier and documentation showing the two procedures addressed different sites or problems. Bundling edits over-apply, so legitimately separate services are frequently recoverable.
The next step
If a number in here matched your practice, that leak is measurable. The 12-Month Missing Money Scan reads your last twelve months of claims and finds the money already earned but never collected. 25% of what is recovered, 20% if you prepay. No recovery, no fee.
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