Skip to main content

N162 Remark Code: Test Outside Lab Certification

N162 is an alert that, although the claim was paid, the lab billed a test or specialty not included in its laboratory certification. If the certification information is not corrected, the payer will deny payment for such tests in the near future.

Quick facts

Code
N162 (RARC N162)
Status
Active In use since February 28, 2003; last modified April 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): The alert itself does not change this payment; it warns about future denials.
  • CO (Contractual Obligation): Once enforcement begins, tests outside the certification will be denied as provider liability.
Official description
Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N162 means

Laboratories are certified under CLIA for specific specialties. Payers compare the tests on a claim with the certification on file. N162 is the warning shot: this claim was paid, but the test fell outside the lab’s certification, and the payer will start denying these tests if nothing changes.

What to do

  1. Identify the test and specialty flagged on the claim.
  2. Check your CLIA certificate to see whether that specialty is listed and the certificate type allows the test.
  3. If the certificate is incomplete, apply to update it through your state survey agency, then confirm the payer’s records are updated.
  4. If the test was sent out, make sure the claim reports the performing lab correctly, or stop billing it under your certificate.
  5. Review other claims for the same test to limit future denials.

Treat N162 as a compliance item: route it to the laboratory director along with billing.

Codes that may appear with N162

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): A routine allowed-amount adjustment on the paid lab line.
  • CO-B23 (Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.): The procedure is not authorized per the lab's CLIA proficiency test, the denial that may follow.
  • MA120 (Missing/incomplete/invalid CLIA certification number.): Missing, incomplete, or invalid CLIA certification number.
  • M91 (Lab procedures with different CLIA certification numbers must be billed on separate claims.): Lab procedures with different CLIA numbers must be billed on separate claims.
  • CO-B7 (This provider was not certified/eligible to be paid for this procedure/service on this date of service.): The provider was not certified or eligible for this service on this date.

N162 FAQ

Which certification does N162 mean?

The laboratory's CLIA certification, which lists the certificate type and the specialties or subspecialties the lab is approved to perform.

How do I correct the certification?

Work with your CLIA state agency to add the specialty or update the certificate, then make sure the payer's records reflect the change.

What if the test was performed by a reference lab?

Then the claim may need to show the performing lab and its CLIA number, or be billed by that lab, depending on payer rules.