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RARC N386 · Remittance Advice Remark Code

RARC N386 Remark Code: This decision was based on a National Coverage Determination (NCD)

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

Not an ICD-10 code. RARC N386 is a remittance-advice remark code published by X12 and carried on the 835 LQ segment. Any ICD-10 code with the same letters and digits (e.g., ICD-10 M15 osteoarthritis, N130 other urinary tract disorders) is a separate, unrelated code set used in diagnoses on the 837. Confirm the context before acting on this page.

TL;DR

RARC N386 (X12 This decision was based on a National Coverage Determination (NCD)). Commonly paired with CARC 11, CARC 50. RARC N386 tells you Medicare based the decision on a specific NCD (National Coverage Determination).

Official X12 description

“This decision was based on a National Coverage Determination (NCD).”

Source: X12 Remittance Advice Remark Codes. X12 publishes and maintains the RARC set; always verify against the current release before building a claim workflow.

Paired CARC codes

RARC N386 almost never appears alone — it accompanies one of the CARCs below on the same 835 remittance line. Fix the CARC and the RARC typically clears; the RARC alone is informational.

Paired CARCWhat the CARC means
CARC 11The diagnosis is inconsistent with the procedure.
CARC 50These are non-covered services because this is not deemed a 'medical necessity' by the payer.
CARC 167This (these) diagnosis(es) is (are) not covered.

What RARC N386 actually means

RARC N386 tells you Medicare based the decision on a specific NCD (National Coverage Determination). Unlike LCDs (regional), NCDs bind all MACs nationally. To appeal, find the NCD on the Medicare Coverage Database, read the covered indications, and match the patient's clinical record to those criteria. NCDs are authoritative — if the NCD excludes the indication, the appeal path is narrow and usually requires a Coverage-With-Evidence-Development or clinical-study enrollment.

Common root causes

  • Indication not on the NCD's covered list.
  • Required clinical-study or registry enrollment not documented (for CED-gated NCDs).
  • Frequency or sequencing condition in the NCD not met.

Prevention checklist

  • Maintain awareness of high-risk NCDs (ICD implants, TAVR, IVC filter retrieval, CAR-T, certain DME).
  • For CED-gated coverage, verify the patient is enrolled in an approved registry before the service.

Resolution & appeal strategy — step by step

Because RARC N386 is supplemental to a CARC, the resolution path usually starts by fixing the underlying adjustment reason. A formal appeal of the RARC alone is rarely necessary.

  1. 1Pull the cited NCD from the Medicare Coverage Database and match the patient's documentation to its criteria.
  2. 2If the NCD is silent on the specific indication, look for the applicable LCD/Article for supplementary coverage guidance.
  3. 3For CED services, attach registry enrollment proof with the appeal.
Sample reconsideration language referencing RARC N386
[Provider letterhead] Re: Reconsideration — Claim #{claim_number}, CARC 11 / RARC N386 Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} The 835 remittance on {remittance_date} carried RARC N386: "This decision was based on a National Coverage Determination (NCD)." We request reconsideration. The attached documentation rebuts the remark code: 1. [State the fact that rebuts the remark — authorization number, primary 835, modifier rationale, LCD citation, etc.] 2. [Reference the paired CARC and the corresponding fix] 3. [Attach the supporting document listed in step 1] Attached: {list supporting documents} Please process this line under the member's benefits. Contact the billing office at {provider_phone} for questions. Sincerely, {billing_manager_name}, {credentials}

Edit the bracketed fields before sending. Payer-specific reconsideration forms are often required — check the provider portal first.

How common is RARC N386?

Platform frequency
Pending ETL

Platform frequency ranks publish once the anonymized denial-rate pipeline reaches the publication threshold (strategy §12 Phase 2).

How QuickRCM handles RARC N386

QuickRCM reads RARC N386 alongside its paired CARC in the 835 LQ segment and routes the line to the correct worker queue with the right documentation already attached:

  • Denial routing rules tuned to the CARC+RARC pair — the paired combination tells QuickRCM which documentation the payer will accept.
  • Reconsideration template for this exact remark code pulls the supporting facts from the claim automatically.
  • Pre-submission scrubs that catch the preventable drivers surfaced on this page before the 837 leaves the clearinghouse.
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Frequently asked questions — RARC N386

What does RARC N386 mean?

RARC N386 is an X12 Remittance Advice Remark Code. The official X12 definition is: "This decision was based on a National Coverage Determination (NCD)." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.

Which CARC is paired with RARC N386?

RARC N386 is most commonly paired with CARC 11, CARC 50, CARC 167. The CARC is the financial adjustment reason; the RARC is the informational remark. Fix the paired CARC first — the RARC usually clears with the corrected claim.

How do I resolve a RARC N386 remark on a remit?

Start from the root cause: Indication not on the NCD's covered list. First step: Pull the cited NCD from the Medicare Coverage Database and match the patient's documentation to its criteria. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.

Where does RARC N386 appear on the 835 ERA?

RARC N386 is carried on the 835 Loop 2110 LQ segment alongside the CARC in the CAS segment of the same service line. The code and its X12 description also print on the paper EOB in the "Remark Code" or "Remark" column next to the corresponding denial or adjustment reason.

Is RARC N386 the same as ICD-10 code N386?

No. RARC N386 is a remittance-advice remark code published by X12 and carried on the 835. Any ICD-10 code with the same letters and digits is a diagnosis code on the 837 HI segment — a completely different code set maintained by the WHO/CMS. Use the transaction context (835 = RARC; 837 = ICD-10) to disambiguate.

Disclaimer

This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. X12 code descriptors are maintained by the X12 External Code Lists; always verify against the current X12 release and the payer's own published policy before submitting or appealing a claim.