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N156 Remark Code: Patient Owes Elective Treatment Difference

N156 is an alert that the patient is responsible for the difference between the approved treatment and the elective treatment. The payer based its payment on the treatment it approves, and the added cost of the elective choice falls to the patient.

Quick facts

Code
N156 (RARC N156)
Status
Active In use since October 31, 2002; last modified April 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The difference between the approved and the elective treatment is the patient's to pay.
  • CO (Contractual Obligation): Any contractual reduction on the approved portion remains the provider's adjustment.
Official description
Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N156 means

When more than one treatment can address a condition, a plan may pay only for the option it approves, often the less costly one. If the patient chooses a different option, the plan still pays based on the approved treatment. N156 tells you the remainder is the patient’s to pay.

What to do

  1. Review the remittance to see the allowed amount for the approved treatment and the patient responsibility.
  2. Bill the patient for the difference, with an explanation of how it was calculated.
  3. Check your contract for any limits on what can be collected from the patient.
  4. Keep consent records showing the patient chose the elective option.

Using predeterminations and written cost estimates before elective treatment lets patients decide with the full picture and reduces billing disputes.

Codes that may appear with N156

  • CO-169 (Alternate benefit has been provided.): An alternate benefit was provided, based on the approved treatment.
  • CO-96 (Non-covered charge(s).): The elective portion is a non-covered charge.
  • N124 (Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the…): A less extensive item was paid and the patient is liable after written notice.
  • N398 (Missing elective consent form.): Missing elective consent form.
  • N399 (Incomplete/invalid elective consent form.): Incomplete or invalid elective consent form.

N156 FAQ

Where does N156 commonly appear?

Often on dental claims, where a plan pays for a standard treatment and the patient chooses a more costly option. It can also appear on other claims with alternate benefit provisions.

How much can I bill the patient?

The amount the remittance assigns to patient responsibility, subject to your contract's rules on balance billing.

Should the patient have been told in advance?

It is good practice, and sometimes required, to explain the likely out-of-pocket cost of an elective choice before treatment. A predetermination can help.