Official CARC description: “This procedure is not paid separately.” Here’s what it actually means, why it fires, and how to get the claim paid.
The line is packaged — into the surgical global, an inpatient payment, or a bundled payment methodology. Sister code of CO 97; the RARC narrows down which packaging rule fired.
Liability group: CO = Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Identify the packaging rule via the RARC and the CPT's status indicators
If separately payable with a modifier (24/25/59/79): corrected claim
If truly packaged: write off — and stop billing the line to save rework
Audit chargemaster/EHR order sets that generate packaged lines
Appeal only with a genuine unbundling story (distinct session/site/problem) and the documentation to prove it — mirror the CO 97 playbook.
Fill in the denial facts — use placeholders, never real patient data (the letter keeps [PATIENT NAME]-style fields so you can merge real details privately). A payer-ready draft with an enclosure checklist comes back in ~20 seconds.
Your appeal letter draft will appear here.
This procedure is not paid separately. In practice: The line is packaged — into the surgical global, an inpatient payment, or a bundled payment methodology. Sister code of CO 97; the RARC narrows down which packaging rule fired.
CO stands for Contractual Obligation — the provider absorbs it — the amount cannot be billed to the patient. If the denial is wrong, the money is recovered by correcting or appealing the claim, not by balance-billing.
Appeal only with a genuine unbundling story (distinct session/site/problem) and the documentation to prove it — mirror the CO 97 playbook.