N413Remark Code (RARC)Active
N413 Remark Code - Frequency Limit Exceeded Explanation
The N413 remark code indicates that the billed service is limited to two occurrences within a benefit year. This means that the payer has determined that the service has already been utilized to the maximum allowable limit for the specified time frame.
How It Relates to the Denial
The N413 remark code typically accompanies adjustment reason codes that indicate a service has been denied or reduced due to exceeding the allowed frequency. This combination signals that the adjustment is related to the frequency limitation of the billed service.
Common Scenarios
1A provider billed for three physical therapy sessions within the same benefit year, but the remittance shows an adjustment for the third session with the accompanying reason code indicating a frequency limit.
→ The N413 remark code clarifies that the third session was disallowed because the patient has already reached the maximum allowed limit of two sessions for the year.
2A claim for chiropractic adjustments was submitted, but the remittance reflects a denial for the second adjustment due to a frequency limit indicated by the adjustment reason code.
→ In this case, N413 explains that the second adjustment was not covered because the patient had already received the maximum of two adjustments allowed within the benefit year.
3A patient received two allergy shots, and a claim was submitted for a third shot, which was denied on the remittance advice with a reason code related to frequency limitations.
→ The N413 remark code indicates that the denial was due to reaching the maximum allowable frequency of two shots within the benefit year.
What to Do
- Review the claim details to confirm the number of times the service was billed within the benefit year.
- Consider resubmitting the claim if the frequency limit is not applicable due to a change in the patient's circumstances.
- Ensure that the services billed do not exceed the allowed frequency as per the payer's policy.
What to Check
- The patient's benefit year limit for the specific service.
- The claim adjustment reason code that accompanies the N413 remark code.
- Documentation of services rendered to confirm the frequency of the billed service.