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N238 Remark Code: Invalid Physician-Certified Plan of Care

N238 means the plan of care the physician (or other allowed practitioner) certified was incomplete or invalid, for example missing a signature, date, goals, or the frequency and duration of services, so it could not support payment.

Quick facts

Code
N238 (RARC N238)
Status
Active In use since August 1, 2004; last modified March 14, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The services were denied or held because the certified plan did not meet requirements. The provider fixes it; the patient is not liable for this.
Official description
Incomplete/invalid physician certified plan of care.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N238 means

For services like outpatient physical, occupational, and speech therapy, home health, and hospice, the plan of care is the backbone of coverage. It spells out the diagnosis, goals, type of services, and how often and how long they’ll be provided. A physician or other allowed practitioner has to certify it. N238 says the certified plan the payer received did not pass. It typically comes with CARC 252 or CARC 272.

What makes a plan invalid

  • The certifying practitioner’s signature or date is missing.
  • Required elements are absent, such as long-term goals, frequency, or duration.
  • Services billed exceed the frequency or fall outside the dates the plan covers.
  • Recertification was due and not obtained, or was signed after the payer’s deadline.
  • The plan was signed by someone the payer does not accept as a certifier for this service.

How to fix it

  1. Compare the plan against the payer’s certification requirements for this service type.
  2. Check whether the billed dates and visit counts fall within the certified period and frequency.
  3. Get a signed, dated certification or recertification from the practitioner; if it’s late, include any explanation the payer permits.
  4. If services exceeded the plan, update the plan going forward and adjust the claim for dates that are not supported.
  5. Send the valid plan and, if needed, a corrected claim with the original claim number.

How to prevent it

Track certification and recertification dates for every patient on a plan of care, and send plans for signature promptly with reminders. Compare visit counts against the certified frequency before each billing cycle.

Codes that may appear with N238

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation, the certified plan of care, is required.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): The payer could not confirm medical necessity without a valid plan.
  • CO-272 (Coverage/program guidelines were not met.): Coverage guidelines requiring a certified plan were not met.
  • M141 (Missing physician certified plan of care.): The physician-certified plan of care was missing entirely.
  • M135 (Missing/incomplete/invalid plan of treatment.): The plan of treatment was missing or invalid.
  • N223 (Missing documentation of benefit to the patient during initial treatment period.): Documentation of benefit during an initial treatment period was missing.

N238 FAQ

Which services require a certified plan of care?

Outpatient therapy, home health, and hospice are common examples, particularly under Medicare. Some commercial and Medicaid plans have similar requirements.

Can a nurse practitioner or physician assistant certify the plan?

Depending on the payer, the service type, and state law, non-physician practitioners may be able to certify. Check the payer's current rules.

What if the certification was signed late?

Some payers accept delayed certification with an explanation. Others limit payment to dates after the signature. Review the payer's policy.