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CARC 97Bundled serviceNCCI or payment-package relationship

CARC 97: Service Included in Another Payment

This adjustment family indicates that payment for the service is considered included in another service or allowance. The underlying rule may be NCCI, global surgery, facility packaging, or another payment policy.

First checks

  1. 1Identify the other service or payment that includes the denied line.
  2. 2Check the edit and payment rule effective for the date and setting.
  3. 3Determine whether a modifier exception is permitted and clinically supported.

Resolution path

  1. 01Post contractually when the inclusion is correct.
  2. 02Correct an unsupported modifier or code choice.
  3. 03When services are truly distinct and the rule permits, submit a supported correction or appeal.
  4. 04Do not append modifier 59 only to force payment.

Evidence packet

  • Operative or encounter record
  • Current NCCI edit and policy manual
  • Distinct encounter, site, practitioner, or service evidence

Prevent the next denial

Check code-pair edits, global periods, status indicators, payment packaging, and modifier documentation before submitting separate lines.

Official sources

CMS Health Care Payment and Remittance AdviceReviewed 2026-07-10CMS National Correct Coding InitiativeReviewed 2026-07-10

Use the current payer notice, contract, code set, policy, and filing instructions. This guide is educational and does not determine patient liability or appeal rights for an individual claim.