CO-97: Benefit included in another service already adjudicated

What it means

CO-97 means the payer considers this service part of another procedure that was already adjudicated. The value is included in the allowance for that other service, so it will not be paid again on its own line.

Mechanically this is a bundling edit. The payer's rules say the denied code is a component of, or is incidental to, another code billed for the same patient and date. As a CO code the amount is a contractual write-off unless you can show the services were separate and separately billable, often with a modifier.

Why it happens in behavioral health

In behavioral health CO-97 commonly appears when component services are billed alongside a program per diem or bundled code. An assessment, care coordination, or ancillary service billed separately from an IOP or PHP day is frequently ruled included in the program rate.

Same-day combinations also trigger it, such as an add-on service the payer considers part of the primary psychotherapy or program encounter. When the services truly were distinct and separately payable, the fix is usually the correct modifier plus documentation, not simple resubmission.

How to fix it

• Identify which paid service the denied line was bundled into.
• Determine whether the two services were genuinely separate and separately billable.
• If separate, append the appropriate modifier and resubmit with supporting documentation.
• If truly bundled, post the write-off and stop billing the component separately.

How to prevent it

• Know which component services are included in your IOP, PHP, and program rates.
• Use correct modifiers when a distinct service is separately payable on the same day.
• Bill program days under the bundled code rather than itemizing included components.

Related denial codes