Postoperative Care / Bundled Services

CARC/RARC Description
CO-97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

 

Common Reasons for Message

  • A separate charge is not allowed because this service is part of major surgical (90 global days) procedure

Next Step

  • Verify that surgery was billed correctly and includes appropriate modifiers
  • Submit an Appeal request – Items or services with this message have appeal rights

Claim Submission Tips

  • Follow instructions on correct use of Modifiers

View reason code list, return to Reason Code Guidance page.

 

Last Updated Aug 08, 2018