CARC 97: The benefit for this service is included in the payment/allowance for another service/procedure
This charge was bundled into a payment that already covered another related service.
What this means for your claim
Bundling rules prevent double payment for related services. For example, a follow-up note may be considered part of a surgical global period and not separately billable.
What to do next
- 1
Ask your provider whether this service falls within a global surgical period or another bundling rule.
- 2
If the service was genuinely separate and distinct (different clinical problem, different anatomical site), a modifier and appeal may allow separate payment.
- 3
Confirm you aren't being billed by the provider for a charge that was correctly bundled.
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