N412Remark Code (RARC)Active
N412 Remark Code - Service Frequency Limit Explanation
The N412 remark code indicates that the billed service is only allowed a maximum of two times within a 12-month period. This means the payer has determined that the frequency of the service exceeds the allowable limit, which is why an adjustment has been applied to the claim.
How It Relates to the Denial
The N412 remark code typically accompanies adjustment reason codes that indicate a service was denied or reduced due to frequency limitations. This combination signals to the biller that while the claim was processed, the service quantity exceeded the payer's established guidelines.
Common Scenarios
1A provider billed for a lab test that was performed three times within the past year. The claim came back with a denial indicating the service was not covered due to frequency limits.
→ The N412 remark code clarifies that the payer allows this specific lab test only twice in a 12-month period, resulting in the denial of the third instance.
2A patient received physical therapy sessions, and the provider submitted a claim for the fifth session within a year. The remittance shows an adjustment with a reason code for frequency limit, along with the N412 remark.
→ The N412 remark is explaining that the patient is only eligible for two physical therapy sessions within a year, leading to the adjustment of the claim.
3A claim for a preventive service was submitted, but the remittance showed a reduction in payment because the service was billed for the third time in less than a year.
→ The N412 remark indicates that the payer has a policy limiting this preventive service to two occurrences per year, which is why the adjustment was made.
What to Do
- Review the frequency of the billed service to ensure it aligns with the payer's limit of two times in a 12-month period.
- If the service was billed in compliance with the limit, consider appealing the adjustment with supporting documentation.
What to Check
- The patient's service history to confirm the number of times the service has been performed in the past 12 months.
- The payer's policy documents regarding frequency limitations for the specific service.
- The claim submission details to verify the service dates and quantities billed.