N415Remark Code (RARC)Active
N415 Remark Code - Service Limited to 1 Time in 18 Months
The N415 remark code indicates that the billed service is limited to one occurrence within an 18-month timeframe. This means the patient is only eligible for this particular service once during that period, and any additional claims for the same service will be denied.
How It Relates to the Denial
The N415 code typically accompanies a claim adjustment reason code that indicates a denial based on frequency limitations. Together, these codes signal that the service has been billed more than the allowed frequency within the specified time period.
Common Scenarios
1A provider submitted a claim for a specific therapy session that the patient received twice within 18 months. The remittance advice returned a denial indicating the service was not covered.
→ In this case, the N415 remark is clarifying that the therapy session is only allowed once in 18 months, which directly relates to the denial for the second occurrence.
2A patient was billed for a preventive service that is only covered once every 18 months, but the provider mistakenly billed for it twice within that time frame.
→ Here, the N415 remark code indicates that the second claim for the preventive service is not payable because it exceeds the allowed frequency, reinforcing the adjustment reason code on the remittance.
3A claim for a diagnostic imaging service was submitted, but the patient had already received the same service within the past 18 months, leading to a denial on the remittance advice.
→ The N415 remark explains that the service is restricted to one occurrence in an 18-month period, confirming why the claim was denied.
What to Do
- Verify the patient's service history to confirm the timing of the previous service.
- Consider resubmitting the claim with appropriate documentation if a different service is warranted or if the 18-month period has elapsed.
- Educate the provider on the frequency limitations for this service to avoid future denials.
What to Check
- The patient's previous claims to identify if the service was billed within the last 18 months.
- The payer's policy documentation regarding frequency limitations for the billed service.
- The eligibility response to ensure the patient meets criteria for the service covered under the plan.