Skip to main content

N116 Remark Code: Home Service Paid Conditionally

N116 is an alert that the payer paid conditionally because the service was provided in the patient's home and the patient might be under a home health episode of care. If an episode is later confirmed, home health consolidated billing applies and the payer can recoup the payment.

Quick facts

Code
N116 (RARC N116)
Status
Active In use since June 30, 2002; last modified November 1, 2016.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any contractual adjustment is the provider's. The alert does not create a patient balance.
  • OA (Other Adjustment): Some payers flag the provisional nature of the payment as an other adjustment.
Official description
Alert: This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency's (HHA's) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N116 means

The key word in N116 is “possible.” The payer does not have evidence of a home health episode; it only knows your claim reported the home as the place of service. Because home health consolidated billing bundles certain therapy services and supplies into the home health agency’s payment, the payer released your payment with a condition attached: it can take the money back if an overlapping episode surfaces.

What to do

  1. Treat the payment as provisional in your accounts receivable notes.
  2. Verify home health status for the service date through eligibility tools or the patient’s physician.
  3. If an episode was open, contact the home health agency. Bundled services are the agency’s responsibility, and any payment to you would come through an arrangement with it.
  4. If none was open, keep proof, so you can contest a recovery if one arrives.

For therapy and supply providers who work in patients’ homes, building a home health check into intake reduces the number of conditional payments that later reverse. The eligibility root-cause guide covers verification practices.

Codes that may appear with N116

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): A standard fee schedule reduction on the paid line, with N116 warning that the payment may be reversed.
  • N88 (Alert: This payment is being made conditionally.): Used when an HHA episode notice is actually on file, a stronger signal of overlap than N116.
  • N70 (Consolidated billing and payment applies.): States that consolidated billing applies rather than that it might.
  • N638 (Reimbursement has been made according to the home health fee schedule.): Reports reimbursement under the home health fee schedule.

N116 FAQ

Why did the place of service trigger this alert?

Services delivered in the home are the ones most likely to overlap a home health episode, so payers pay them conditionally until overlap can be ruled out.

What should I keep on file?

Documentation of how you checked for home health status, and any confirmation from the patient or eligibility response that no episode was open.

Is there anything to correct on the claim?

No. If the place of service was accurate, nothing needs to change. N116 only warns of a possible later adjustment.