N676Remark Code (RARC)Active
N676 Remark Code - Outpatient Facility Fee Schedule Denial
The N676 remark code indicates that the billed service does not meet the criteria for payment under the Outpatient Facility Fee Schedule. This means that the service rendered is not eligible for reimbursement based on the established outpatient fee guidelines.
How It Relates to the Denial
The N676 remark code typically accompanies a Claim Adjustment Reason Code that indicates a denial or adjustment related to outpatient services. Together, they signal that the service billed is not covered under the applicable facility fee schedule.
Common Scenarios
1A facility submits a claim for an outpatient surgical procedure, but the payment comes back with an adjustment indicating non-coverage.
→ The N676 remark code clarifies that the outpatient surgical procedure billed does not qualify for payment under the Outpatient Facility Fee Schedule, pointing to a coverage issue.
2A claim for an outpatient diagnostic test is submitted, but the remittance shows a denial with a reason related to the facility fee schedule.
→ Here, the N676 remark code suggests that the diagnostic test does not meet the payment criteria outlined in the Outpatient Facility Fee Schedule, indicating it may not be a covered service.
3A provider bills for a series of outpatient therapy sessions, but receives an adjustment stating that payment is denied due to fee schedule limitations.
→ The presence of the N676 remark code indicates that these therapy sessions do not qualify for reimbursement under the Outpatient Facility Fee Schedule, signaling a need to review coverage policies.
What to Do
- Review the outpatient facility fee schedule to determine if the service is covered.
- Consider whether the service was performed in an eligible outpatient setting.
- Check if any documentation or coding errors contributed to the denial.
What to Check
- The specific outpatient facility fee schedule for the payer.
- The claim details to confirm the setting where the service was performed.
- The accompanying Claim Adjustment Reason Code for additional context on the denial.