Denial CO-97: Bundled Into the Global OB Package
CO-97 means the payer decided the service is included in another paid service, on OB claims, almost always the global package. It is one of the most overturnable denials in maternity billing: ultrasounds, NSTs, and distinct problem visits are not part of the global bundle, and an appeal citing the package definition usually wins.
Why CO-97 fires on OB claims
The global obstetric package makes payer bundling engines trigger-happy. Any service billed during the antepartum window with a pregnancy diagnosis can get swept into “included in the allowance for another service.” The three most common false positives:
- Obstetric ultrasounds (
76805,76811,76815): never part of the global package - Fetal non-stress tests (
59025): separately billable with a surveillance indication - Problem E/M visits: hypertension, diabetes, and other complications beyond routine care are outside the bundle when documented with their own diagnosis
The appeal that works
State the package definition, then show the service falls outside it:
- Cite that the global OB package covers routine antepartum visits, delivery, and routine postpartum care, and that diagnostic services are excluded
- Attach the order and interpretation for the denied service with its distinct indication
- For problem visits, attach the note showing evaluation beyond routine prenatal care, with the complicating diagnosis primary
- Reference the specific NCCI guidance; bundling appeals that cite the edit rationale get reviewed differently than “please reconsider”
When CO-97 is correct
Not every CO-97 is wrong. Routine visits billed individually alongside a global code, heart-tone checks billed as NSTs, or a postpartum visit billed separately inside the global window are genuinely bundled. Confirm the service actually falls outside the package before appealing; the global package guide has the full inside/outside line.
FAQ
What does denial code CO-97 mean? The benefit for this service is included in the payment for another service already adjudicated. On OB claims it usually points at the global maternity package.
Can I appeal CO-97 on an ultrasound during pregnancy? Yes. Obstetric ultrasounds are excluded from the global package. Appeal with the interpretation report and the indication, citing the package definition.
Does modifier 25 fix CO-97? Only for same-day E/M bundling. Modifier 25 defends a significant, separately identifiable visit on the same day as another service; it does not apply to the ultrasound and NST bundling cases.