N428Remark Code (RARC)Active
N428 Remark Code - Not Covered by Place of Service
The N428 remark code indicates that a service billed is not covered when performed in the specified place of service. This typically means that the payer has specific coverage rules that exclude reimbursement for that service in the given location.
How It Relates to the Denial
The N428 remark code generally accompanies a Claim Adjustment Reason Code that indicates a denial or reduction related to the place of service. When paired, these codes signal to the biller that the denial is specifically due to the service not being covered in that location.
Common Scenarios
1A provider billed for a surgical procedure performed in an outpatient facility. The remittance returned with a denial for the service along with the N428 remark code.
→ The N428 remark code suggests that the surgical procedure is not covered when performed in an outpatient setting, indicating the need to review the payer's policy on covered services in that location.
2A claim was submitted for a physical therapy session conducted in a patient's home, but the remittance included a denial and the N428 remark code.
→ Here, the N428 remark code is pointing out that the physical therapy service is not covered when provided in a home setting, which may reflect the payer's guidelines on service locations.
3A claim for a diagnostic test performed in a retail clinic was denied, and the remittance included the N428 remark code.
→ The presence of the N428 remark code indicates that the payer does not cover the diagnostic test performed in a retail clinic, highlighting the importance of checking coverage policies for such locations.
What to Do
- Review the place of service listed on the claim to ensure it matches the payer's covered locations.
- Consult the payer's policy on service coverage to verify if the service is indeed excluded at the billed location.
- Consider resubmitting the claim with the service performed in a covered place of service, if applicable.
What to Check
- The claim submission details, specifically the place of service code.
- The payer's benefit documentation regarding coverage limitations for specific services by location.
- Any previous correspondence or policy updates from the payer regarding place of service denials.