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N33 Remark Code: No Health Check Before Treatment

N33 means the payer has no record of a required health check before the treatment began. Some programs, often Medicaid children's health programs, require a preventive checkup or screening first, and pay for follow-up treatment only after it is documented.

Quick facts

Code
N33 (RARC N33)
Status
Active In use since January 1, 2000.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The treatment is denied under program rules. The provider generally cannot bill the patient or family for it.
  • PI (Payer Initiated Reduction): A payer-initiated adjustment under program requirements, common in government programs.
Official description
No record of health check prior to initiation of treatment.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N33 means

Certain programs link access to some treatment services to a prior preventive visit. The idea is that a comprehensive screening identifies the need for treatment, and treatment follows from it. N33 is the payer saying it looked for that screening in its records before the start of treatment and found nothing.

This is most often seen with state Medicaid programs for children, where screening visits under the EPSDT benefit feed into referrals for dental, vision, therapy, or other care. The exact rules are set by each program. N33 commonly pairs with CARC 272 or CARC 96.

Common causes

  • The child had no periodic screening within the window the program requires.
  • The screening happened, but the claim for it was denied, pending, or billed under a different member ID.
  • The screening was performed by a provider not recognized by the program as qualified.
  • Treatment began before the screening date.
  • A required referral from the screening provider was not documented.

What to do

  1. Ask the family and your records whether and when a checkup was done, and by whom.
  2. Contact the screening provider to confirm the checkup was billed and paid.
  3. Ask the payer to recheck its history if a qualifying checkup exists, and provide the date and provider.
  4. Appeal with evidence if the payer’s records are wrong.
  5. Refer the patient for a checkup before further treatment, so future claims can be paid.

How to prevent it

Before scheduling treatment for program members, confirm the last screening date through the program’s eligibility or history tools. Coordinate with primary care providers so screening results and referrals reach specialists before treatment begins.

Codes that may appear with N33

  • CO-272 (Coverage/program guidelines were not met.): Coverage or program guidelines were not met, specifically the health check prerequisite.
  • CO-96 (Non-covered charge(s).): The treatment is non-covered as billed because the prerequisite was not on record.
  • N78 (The necessary components of the child and teen checkup (EPSDT) were not completed.): The child and teen checkup (EPSDT) was performed but required components were not completed.
  • N146 (Missing screening document.): A required screening document is missing.
  • N243 (Incomplete/invalid/not approved screening document.): The screening document is incomplete, invalid, or not approved.

N33 FAQ

What counts as a health check?

It depends on the program. In many Medicaid programs, it means a periodic well-child or EPSDT screening. Some states call these checkups by their own program name.

What if the checkup was done by another provider?

The payer may simply not have that claim yet, or it may be under a different ID. Get the date and provider of the checkup and ask the payer to recheck its records.

Can a checkup after treatment fix the denial?

Usually not for treatment already delivered, because the rule is that the check comes first. Ask the payer whether any exception or retroactive process applies.