Skip to main content

N189 Remark Code: One-Time Benefit Exception Paid

N189 is an alert that the payer paid this service as a one-time exception to the plan's normal benefit restrictions. The payment stands, but it does not set a precedent for future claims of the same kind.

Quick facts

Code
N189 (RARC N189)
Status
Active In use since February 28, 2003; last modified April 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Any remaining contractual adjustments apply as usual; N189 only explains why the service was paid despite a restriction.
  • PR (Patient Responsibility): Patient cost-sharing, if any, still applies to the paid service.
Official description
Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N189 means

N189 is good news with a warning attached. The payer paid for something its plan normally restricts, such as a service beyond a visit limit, an item outside the usual frequency, or care that the plan typically excludes. It is flagging that the decision was a single exception.

Because it is an alert, there is nothing to correct. The more important use of N189 is planning: if the patient needs the same service again, the practice should not assume it will be covered.

What to do

  1. Post the payment and adjustments normally.
  2. Add a note to the patient’s account and, if relevant, the treatment plan, stating that the prior payment was an exception.
  3. Before scheduling a repeat of the service, verify benefits and ask whether authorization or another exception request is needed.
  4. Let the patient know that future services may not be covered the same way, so they are not surprised by a later denial.

Tracking exception payments on your remittances can also show which payers are open to case-by-case review. The ERA Analyzer can help spot patterns like this across remittances.

Codes that may appear with N189

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): A standard fee-schedule reduction may still appear on the paid line.
  • PR-2 (Coinsurance Amount): Coinsurance may apply to the excepted service like any other covered service.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Consult plan benefit documents for restrictions on this service, the rule the exception bypassed.
  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): Benefit maximum reached, a restriction that sometimes prompts one-time exceptions.
  • CO-96 (Non-covered charge(s).): Non-covered charges, the usual result when no exception is granted.

N189 FAQ

Will the next claim for the same service be paid?

Not necessarily. N189 says the exception was one time. Future claims will be judged under the normal restrictions unless the payer grants another exception.

Do I need to do anything?

Post the payment and note the exception in the patient's account. Before repeating the service, check benefits or request authorization again.

Why would a payer make a one-time exception?

Reasons vary, such as a successful appeal, a case management decision, or a payer error correction. The remark does not say which.