Claims · Updated 2026-09-08 · 5 min read
What does a 'bundled' or 'inclusive' denial look like on the EOB?
CARC 97 with RARC M15 or N20 beside it and a sentence saying the fee is included in another completed service. Bundling is the 7th most common denial reason.
A bundled denial shows up as an adjustment code plus a sentence. The code is almost always CARC 97 — "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated" — or its same-day variant CARC P14, with a remark code beside it: RARC M15 for services bundled as components of another procedure, RARC N20 for a service not payable with another service on the same date, or RARC N70 where consolidated billing applies. The sentence next to the code is what actually tells you which procedure absorbed the line. As of September 2026, bundling was the 7th most common denial reason across the claims we measure — 3,306 denied lines, 5.0% of all denials, at 32 of 37 practices and from 64 different payers.
What we measured
| rank | reason | denied lines | practices | payers | share of denials |
|---|---|---|---|---|---|
| 1 | Procedure not covered by the plan | 14,609 | 37 | 172 | 22.3% |
| 2 | Frequency limitation | 9,451 | 34 | 119 | 14.4% |
| 3 | Age limitation | 5,991 | 29 | 84 | 9.1% |
| 4 | Annual maximum met | 5,121 | 33 | 87 | 7.8% |
| 5 | Other or unclassified | 4,950 | 9 | 78 | 7.6% |
| 6 | Provider credentialing issue | 4,596 | 12 | 32 | 7.0% |
| 7 | Bundled into another procedure | 3,306 | 32 | 64 | 5.0% |
| 8 | Duplicate of previously completed treatment | 2,938 | 32 | 107 | 4.5% |
| 24 | Missing tooth clause | 87 | 13 | 15 | 0.1% |
The top of the ranked denial reasons, with the missing tooth clause shown for contrast. About 65,500 denied lines across 37 practices and more than 170 payers, all dates, measured on 8 September 2026. A denied line is one paid at zero with a reason stored.
What the carriers' own policies say
The generic X12 language is what a patient sees, whichever carrier sent the statement:
CARC 97 — "The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated." CARC P14 — "The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. To be used for Property and Casualty only." RARC M15 — "Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed." RARC N20 — "Service not payable with other service rendered on the same date."
P14 carries its own scope line, and dental is not property and casualty — but Delta's mapping of its denial sentences uses P14 anyway, so it does reach dental statements.
Delta Dental's own mapping of its denial sentences to those codes shows what the English beside the code says. Its general bundling narrative, mapped to RARC M15 and CARC 97:
"According to our guidelines, the fee for this procedure is considered to be part of, and included in the fee for a completed service."
Its x-ray version, mapped to RARC N22 and CARC 97, and the one that answers "why was my pano paid as a series":
"The combined fees for radiographic images are equal to or more than the fee for a complete radiographic image series. Therefore, according to our guidelines, the radiographic images are considered to be equivalent to a complete series. Contracting providers agree to charge the patient only the amount indicated as 'Patient Pays.'"
Its core buildup version:
"According to our guidelines, the fee for buildups are included in the fee for the completed restoration, unless there is extensive loss of tooth structure (50 percent or more) as evidenced by radiographic images."
And the one that states the liability outright:
"Dental coding updated: This is not a separately payable service. Under our guidelines the fee for this procedure is included in the fee for another dental procedure. For this reason we are unable to pay this charge. Neither the plan nor enrollee is responsible for payment of this service."
Why it depends on the plan
One caution matters more than the rest. CARC 96, "Non-covered charge(s)", is a money bucket rather than a cause, and carriers use it for bundling denials as well as for genuinely non-covered services. Delta's Medicaid rebundling narrative — periapicals billed with a complete series "will be rebundled and considered part of the full mouth series" — carries CARC 96, not 97. So the adjustment code alone does not tell you what happened. The sentence beside it does.
The other variable is vocabulary. The same event is called "integral" by MetLife and United Concordia, "inclusive" by Cigna, Aetna and Liberty, "part of a more comprehensive procedure" by Guardian, and "rebundled" when the carrier recodes rather than denies. All of them mean the line was paid inside another line.
What to do
- Read the sentence, not just the code. It names the procedure that absorbed the line, which is what an appeal or a patient explanation has to address.
- Check whether the amount was moved to the write-off column or to patient responsibility before you post it. On a participating claim a bundled line belongs in the write-off column.
- Treat CARC 96 with the same care as CARC 97 — it is used for both non-covered services and bundling, and only the narrative separates them.
- Where the carrier recoded rather than denied, post the paid line under the code the carrier used, so the patient's frequency history matches the carrier's.
- Do not bill a patient a bundled line on a participating claim. Delta's own narrative says neither the plan nor the enrollee is responsible; the protection comes from the network agreement, so an out-of-network dentist may charge for the service separately.
Numbers last refreshed September 2026.