RARC M97: Not Paid to Practitioner in This Place of Service — Paid to Facility
RARC M97 means the service is not paid to the practitioner when provided in this place of service because payment is included in the reimbursement issued to the facility. It flags site-of-service and consolidated-billing conflicts — commonly SNF consolidated billing and technical components billed from facility settings.
- Type
- Informational (supplemental)
- Usually paired with
- CO-97
- Fixable?
- Sometimes — split PC/TC correctly or bill the facility
- Typical fix
- Bill professional component only, or invoice the SNF/facility
What does remark code M97 mean?
Official X12 text: "Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility." Translation: for this setting, the money for this service is inside the facility's check, not yours. The two big engines behind it are SNF consolidated billing and professional/technical component splits in facility settings.
ERA mini-example: a podiatrist bills 11721 with global X-ray code 73630 at $95.00 for a patient seen at a nursing facility. The X-ray line denies CO-97 with M97 — the technical component belongs to the facility. Rebilled as 73630-26 (professional read only), the line pays $11 and change; the film itself is the facility's claim.
Which denial code does M97 come with?
Almost always CO-97 — payment included in another service or provider's reimbursement. The group code CO makes it a provider-side issue: the patient owes nothing extra. Check combinations in the denial code lookup, and review modifier 26 and modifier TC for the component split.
How do you fix an M97 denial?
- Confirm the true place of service and the patient's stay status on the date — in a Part A SNF stay, consolidated billing applies.
- If POS was miscoded, submit a corrected claim with the actual setting.
- If the setting is right, rebill payable pieces correctly: professional component with modifier 26, E/M services excluded from consolidated billing as-is.
- Invoice the facility for the included services under your agreement with them.
How do you prevent M97?
Flag SNF and facility patients at scheduling and check Part A stay status through eligibility — the stay status, not the building, drives consolidated billing. Configure your system so global radiology and diagnostic codes automatically split to the professional component when POS is 21, 22, or 31. Mobile providers (podiatry, optometry, portable X-ray adjacent services) should audit their facility book quarterly; M97 patterns there mean revenue quietly moving to write-off that a billing agreement would capture.
Frequently asked questions
Because facility payment systems already include certain services. When a patient is in a Part A SNF stay, consolidated billing folds most therapy, supplies, and many diagnostics into the SNF payment — practitioners must bill the SNF, not Medicare. Similarly, the technical component of an X-ray done on hospital equipment belongs to the hospital; the practitioner can bill only the professional read.
Split the claim. Bill Medicare for the professional component or the practitioner services excluded from consolidated billing (most physician E/M visits are excluded and still payable). For the included services, invoice the SNF directly under your arrangement with them — which is why you want that arrangement in writing before treating SNF residents.
Often. If the patient was actually seen in your office but the claim went out with POS 31 or 21, the payer applies facility logic to an office service and M97 fires. Verify where care happened; a corrected claim with the true POS resolves it without any facility involvement.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
Stop losing revenue to problems like this.
A free billing audit shows exactly where your practice is leaking money — no cost, no commitment.
