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N160 Remark Code: Patient Must Choose an Option First

N160 means the patient must choose an option before payment can be made for this procedure, equipment, supply, or service. The payer needs the patient's election, commonly between renting and purchasing equipment, and it was not on record.

Quick facts

Code
N160 (RARC N160)
Status
Active In use since February 28, 2003; last modified February 1, 2004.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Payment is on hold for the missing election. The supplier obtains the choice and resubmits; the patient is not billed for the denial.
Official description
The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N160 means

For certain items, especially durable medical equipment, the payer’s rules give the patient a choice that changes how the item is paid, most often renting versus buying. Until that choice is made and reported, the payer does not know which payment method to use. N160 means the election was missing.

It frequently accompanies CARC 106 or CARC 108.

Common causes

  • The supplier delivered the item before offering the patient the options.
  • The patient chose, but the claim lacked the modifier that reports the choice.
  • The election form was unsigned or undated.
  • The item changed categories, and a new election was required but not obtained.

How to fix it

  1. Review the payer’s policy for the item to confirm what election is required and when.
  2. Contact the patient if no choice was made, explain the options in writing, and get a signed, dated election.
  3. Add the correct modifier to the equipment line (CMS-1500 box 24D) reflecting the patient’s choice.
  4. Send a corrected claim with resubmission code 7 in box 22 and the original claim number, or a new claim if the original was rejected.

How to prevent it

Build the election into your intake workflow for every item that requires one, and do not release the first claim until the signed election is scanned into the record. A billing rule that blocks these items without the election modifier catches misses before submission.

Codes that may appear with N160

  • CO-106 (Patient payment option/election not in effect.): The patient payment option or election is not in effect.
  • CO-108 (Rent/purchase guidelines were not met.): Rent or purchase guidelines were not met.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information, such as the modifier that reports the election.
  • N171 (Payment for repair or replacement is not covered or has exceeded the purchase price.): Payment for repair or replacement is not covered or exceeds the purchase price.
  • N170 (A new/revised/renewed certificate of medical necessity is needed.): A new, revised, or renewed certificate of medical necessity is needed.
  • N108 (Missing/incomplete/invalid upgrade information.): Missing or invalid upgrade information.

N160 FAQ

What options does a patient typically choose between?

For some durable medical equipment, Medicare and other payers let the patient choose whether to rent or buy. Other payers may have their own option rules for particular items.

How is the choice shown on the claim?

Usually with a modifier on the equipment line that reflects the patient's election, plus a signed election kept on file. Check the payer's DME policy for the specific modifier.

Can I choose for the patient?

No. The election belongs to the patient. Explain the options, document their decision, and keep it with the order.