Benefit included in the payment/allowance for another service already adjudicated

Why this happens on dental claims

• Bitewings or periapical images bundled into a full mouth series taken in the same period
• Pulp caps, bases, liners, and local anesthesia bundled into the restoration fee
• Limited exams billed with same-day procedures, or panoramic images bundled with a full mouth series

How to appeal CO-97

1. Identify which paid procedure the payer bundled this service into, from the remittance or a status call
2. Check the CDT descriptors and the plan's processing policy: some bundles are plan policy, but others misapply when services occurred on different dates or sites
3. Appeal with documentation that the services were separate and independently necessary, including times, teeth, and quadrants
4. If the bundling is contractual plan policy, confirm whether the amount can be billed to the patient or must be written off under your participation agreement

How to prevent it

• Learn each major payer's bundling policies for radiographs, pulp caps, and same-day exams, and schedule or document accordingly