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RARC N431 · Remittance Advice Remark Code

RARC N431 Remark Code: Service is not covered with this procedure

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Updated

Not an ICD-10 code. RARC N431 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 N431 (X12 Service is not covered with this procedure). Commonly paired with CARC 97, CARC 234. RARC N431 denies because the payer's policy excludes this combination — often an NCCI or payer-specific bundling rule.

Official X12 description

“Service is not covered with this procedure.”

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 N431 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 97The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.
CARC 234This procedure is not paid separately.
CARC 236This procedure or procedure/modifier combination is not compatible with another procedure/procedure/modifier combination provided on the same day according to…

What RARC N431 actually means

RARC N431 denies because the payer's policy excludes this combination — often an NCCI or payer-specific bundling rule. Review the rule; apply distinct modifier or accept the bundling.

Common root causes

  • NCCI/payer-policy bundling rule.

Prevention checklist

  • NCCI and payer rule maintenance.

Resolution & appeal strategy — step by step

Because RARC N431 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. 1Apply modifier 59/XE/XP/XS/XU if distinct, else close.
Sample reconsideration language referencing RARC N431
[Provider letterhead] Re: Reconsideration — Claim #{claim_number}, CARC 97 / RARC N431 Member: {member_name} · Member ID: {member_id} Date(s) of Service: {dos} The 835 remittance on {remittance_date} carried RARC N431: "Service is not covered with this procedure." 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 N431?

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 N431

QuickRCM reads RARC N431 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 N431

What does RARC N431 mean?

RARC N431 is an X12 Remittance Advice Remark Code. The official X12 definition is: "Service is not covered with this procedure." It is supplemental to a Claim Adjustment Reason Code (CARC) on the same 835 line.

Which CARC is paired with RARC N431?

RARC N431 is most commonly paired with CARC 97, CARC 234, CARC 236. 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 N431 remark on a remit?

Start from the root cause: NCCI/payer-policy bundling rule. First step: Apply modifier 59/XE/XP/XS/XU if distinct, else close. Because RARCs are supplemental, the resolution is almost always to address the paired CARC rather than appeal the RARC alone.

Where does RARC N431 appear on the 835 ERA?

RARC N431 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 N431 the same as ICD-10 code N431?

No. RARC N431 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.