Skip to main content

N113 Remark Code: Only One Initial Visit Covered

N113 means only one initial visit is covered per physician, group practice, or provider. The payer found that an initial (new patient or first) visit had already been paid for this patient with the same provider or group, so another initial visit was denied.

Quick facts

Code
N113 (RARC N113)
Status
Active In use since April 16, 2002; last modified June 30, 2003.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): A coding or frequency denial. The provider usually cannot bill the patient; recoding to an established-patient service may be possible.
Official description
Only one initial visit is covered per physician, group practice or provider.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N113 means

Payers pay a higher rate for the first encounter because it takes more work to establish a relationship with a patient. To control that, they limit how often an initial visit can be paid for the same patient by the same provider or group. N113 tells you this claim ran into that limit.

It commonly explains CARC B16, which covers new patient qualifications, or a frequency reason code.

Common causes

  • The patient was seen by another physician of the same specialty in the group, and the payer treats the group as one provider.
  • The patient returned after a gap, and the practice coded them as new under its own rule rather than the payer’s.
  • A physician joined the group and brought patients along, and their previous visits count toward the new group.
  • Initial visits for different problems were both coded as initial, though the payer allows only one.

How to fix it

  1. Review the patient’s history with the provider and group, including visits under previous tax IDs if the payer links them.
  2. Apply the payer’s definition of a new or initial patient to the facts.
  3. If an established-patient or subsequent visit code fits, send a corrected claim with that code, resubmission code 7 in CMS-1500 box 22, and the original claim number.
  4. If the initial visit was valid (for example, different specialty, or outside the look-back period), appeal with the history and the payer’s policy language.

How to prevent it

Before scheduling, check whether the patient has been seen by anyone in the group. Your practice management system can flag prior encounters by patient and specialty so staff do not code an initial visit when the payer will reject it.

Codes that may appear with N113

  • CO-B16 ('New Patient' qualifications were not met.): New patient qualifications were not met; N113 explains that an initial visit was already covered.
  • CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): The information does not support this many or this frequency of services.
  • CO-B14 (Only one visit or consultation per physician per day is covered.): Only one visit or consultation per physician per day is covered, a related visit-limit denial.
  • N666 (Only one evaluation and management code at this service level is covered during the course of care.): Limits one evaluation and management code at a given level during a course of care.
  • M86 (Service denied because payment already made for same/similar procedure within set time frame.): Denies a service already paid for a same or similar procedure within a time frame.

N113 FAQ

Does a new physician in the same group get a new initial visit?

Often not. Many payers apply the limit at the group level when the physicians share a specialty, so a patient seen by one member is established for the others. Rules vary by payer and specialty.

What if years have passed since the last visit?

Payer rules differ. Some treat a patient as new again after a period with no professional services from the group; check the payer's definition before coding an initial visit.

Can I resubmit with an established patient code?

Yes, if the documentation supports that level of service. Send it as a corrected claim so it does not look like a duplicate.