# CARC 97 Denial Code (Procedure Included in Allowance for Another Service (Bundled)) | ANSI 835 EDI Spec
> Comprehensive healthcare EDI technical reference and denial resolution guide for Claim Adjustment Reason Code 97 (Procedure Included in Allowance for Another Service (Bundled)) under ANSI ASC X12 835 005010X221A1.

- **Canonical URL:** https://stanzaapi.com/tools/x12-parser/carc/carc-97-bundled-service
- **Governing Standard:** ANSI ASC X12 Standards (005010) (Accredited Standards Committee X12 / HIPAA 5010)
- **Edge Latency SLA:** <2ms Edge (Cloudflare V8 Isolates)
- **Execution Model:** Pure compute $f(x) = y$, 100% In-Memory (Zero Store, Zero Log)

## Technical Overview & Governing Rules
Claim Adjustment Reason Code (CARC) 97 communicates: "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.".

In ANSI X12 835 Electronic Remittance Advice (ERA) files, CARC 97 is reported in Loop 2110 (Service Payment Information) or Loop 2100 (Claim Payment Information) under the Claim Adjustment (CAS) segment with Group Code 'CO' (Contractual Obligation), formatted as: CAS*CO*97*AMOUNT~.

Root Cause: Payer’s National Correct Coding Initiative (NCCI) unbundling edits determined the service is a component of a comprehensive primary procedure billed on the same encounter.

Adjudication & Appeal Strategy: Evaluate clinical documentation to verify if distinct procedural service was performed; if warranted by NCCI guidelines, append modifier 59, XE, XP, XS, or XU and appeal.

## Specification Matrix
| Attribute | Value | Technical Guidance |
| --- | --- | --- |
| Reason Code | CARC 97 | Procedure Included in Allowance for Another Service (Bundled) |
| Standard Group Code | CO | Contractual Obligation |
| ANSI 835 Segment | CAS*CO*97*AMOUNT~ | Loop 2110 or Loop 2100 |
| Balance Billing Patient | Strictly Prohibited. | Compliance with billing regulations |
| Common RARCs | M15, N390 | Remittance Advice Remark Codes |
| Recommended Action | Evaluate clinical documentation to verify if distinct procedural service was performed; if warranted by NCCI guidelines, append modifier 59, XE, XP, XS, or XU and appeal. | Workflow for billing teams |

## Standard JSON Response Model
```json
{
  "transactionType": "835",
  "claimNumber": "CLM-2026-001",
  "adjudication": {
    "billedAmount": 500,
    "paidAmount": 0,
    "adjustments": [
      {
        "groupCode": "CO",
        "groupName": "Contractual Obligation",
        "reasonCode": "97",
        "reasonDescription": "Procedure Included in Allowance for Another Service (Bundled)",
        "adjustmentAmount": 500
      }
    ]
  }
}
```

## Frequently Asked Questions & Edge Cases
### Q: What does CARC 97 mean on an 835 ERA?
**A:** CARC 97 signifies: "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.". It explains why the payer did not pay the full billed charge.

### Q: Can a provider balance-bill the patient for CARC 97?
**A:** Strictly Prohibited.

### Q: How do medical billing teams resolve and appeal CARC 97?
**A:** Evaluate clinical documentation to verify if distinct procedural service was performed; if warranted by NCCI guidelines, append modifier 59, XE, XP, XS, or XU and appeal.