AGAR Guide
CARC128ReferenceCurrentVerified Aug 15, 2026

CARC 128

AR Guide workflow

Step-by-step: Bundling & Included Services

✓ Workflow verified Aug 15, 2026 · Verified via review of official sources and AR Guide practice testing — not payer policy. View the full guide

  1. VerifySteps 1–10

    1. Which service the payment was included in

    2. Bundling edit / global period rule applied

    3. Remark code explaining the specific reason

    4. Whether the services were genuinely distinct and documented

    5. Modifiers used on the claim

    6. CARC 97 / 234 and the accompanying remark code

    7. Confirm which service the payment was included in

    8. Review the bundling edit or global period rule applied

    9. Check the accompanying remark code for the specific reason

    10. Confirm the services were genuinely distinct and separately documented

  2. ActSteps 11–13

    1. If the bundling is correct, no action — the service is paid within the other allowance

    2. If bundled incorrectly, appeal with the applicable coding guidance and documentation

    3. For future claims, use the appropriate modifiers and billing arrangements to avoid the edit

  3. Document & QASteps 14–19

    1. The bundling edit or global period reference

    2. Clinical documentation showing the services were distinct

    3. Coding guidance supporting separate payment

    4. Run NCCI and bundling edits before submission

    5. Confirm modifier usage is documented when services are distinct

    6. Track bundling denial patterns by payer

Usually no action — appeal only when the bundling is wrong: Note

If the service is genuinely included in another service's payment (global period, NCCI), the correct action is no action — the payment is already in the other allowance. Appeal only when the bundling was applied incorrectly.

If you take the wrong path: Appealing correct bundling is denied and wastes effort. Accepting incorrect bundling leaves legitimate reimbursement on the table.

AR Guide explanation

What it means

The newborn's services are covered in the mother's allowance.

AR Guide knowledge

Common denial category

Bundling & Included Services — The payment for this service is included in the payment for another service — a global period, an NCCI edit, or a plan rule that bundles the service.

AR Guide knowledge

Most common causes

  • Newborn services billed separately instead of within the mother's allowance

AR Guide knowledge

Action in your PM/EMR system

In your PM system: confirm which service the payment was included in before acting. If the bundling is correct, mark it resolved with no resubmission. If incorrect, appeal with the coding guidance and documentation.

Illustrative scenario

Real-world example

A procedure was denied with CARC 97 because its payment was included in the primary procedure's allowance. The bundling was correct, so the correct action was no action.

Example — not a claim about any specific payer or account.

AR Guide knowledge

What AR should verify

  1. Confirm the plan's newborn coverage rules
  2. Check how the mother's claim was adjudicated

AR Guide knowledge

Recommended action

  1. Bill newborn services per the plan's newborn coverage instructions
  2. If allowed, appeal for separate payment with plan documentation

Appeal template

No code-specific template yet

No downloadable template targets CARC 128 specifically. Browse all appeal letter templates — or follow the recommended workflow above.

About this guidance: Note

AR Guide knowledge is general reference content written by our team — it is not payer-specific policy and never replaces the payer’s documentation or your contract. Always confirm specifics with the payer.

Priority 2

Commonly paired RARCs

RARCs commonly accompany CARC 128 on the ERA/EOB. Select the one on your line to focus the workflow, or use the list as a lookup.

  • RARCN15Services for a newborn must be billed separately.
  • RARCN20Service not payable with other service rendered on the same date.Identify which same-date service the payer treated as mutually exclusive and confirm it was paid. If the rule was applied incorrectly (the services are separately billable), appeal with the coding guidance; otherwise no action.
  • RARCM2Not paid separately when the patient is an inpatient.Confirm the service was part of the inpatient payment. If it is genuinely bundled, no action — appeal only when the service should have been separately payable under the payer's policy.
  • RARCN122Add-on code cannot be billed by itself.Bill the add-on code with its required primary procedure code, or appeal if the primary was separately processed.

Priority 3

Payer-specific nuance

How major payers handle this denial — what AR Guide has verified, and what you must confirm with the payer. We never publish payer handling we have not verified.

Medicare

Bundling edits, global periods and NCCI application vary by payer and contract. Confirm which edit was applied before appealing, and support separate payment with coding guidance and documentation.

Medicaid

Bundling edits, global periods and NCCI application vary by payer and contract. Confirm which edit was applied before appealing, and support separate payment with coding guidance and documentation.

UnitedHealthcare

Bundling edits, global periods and NCCI application vary by payer and contract. Confirm which edit was applied before appealing, and support separate payment with coding guidance and documentation.

Aetna

Bundling edits, global periods and NCCI application vary by payer and contract. Confirm which edit was applied before appealing, and support separate payment with coding guidance and documentation.

Cigna

Bundling edits, global periods and NCCI application vary by payer and contract. Confirm which edit was applied before appealing, and support separate payment with coding guidance and documentation.

Anthem (BCBS)

Bundling edits, global periods and NCCI application vary by payer and contract. Confirm which edit was applied before appealing, and support separate payment with coding guidance and documentation.

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