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N381 Remark Code: Consult Your Contract With the Payer

N381 is an informational alert. The payer is directing you to your contractual agreement for restrictions, billing rules, or payment information that apply to these charges.

Quick facts

Code
N381 (RARC N381)
Status
Active In use since April 1, 2007; last modified July 1, 2015.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Adjustments on the line are based on your contract with the payer. They are generally not billable to the patient.
Official description
Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N381 means

N381 doesn’t explain the adjustment in detail. Instead, it points you to where the answer lives: your contract with the payer. The charges on this line were processed under terms in that agreement, such as a fee schedule, a carve-out, a service restriction, or a billing requirement.

It often appears with CARC 45, and with CARC 256 or 131 for contract-specific denials or discounts.

What to do

  1. Read the CARC to see what happened to the charge.
  2. Find the relevant part of your contract: the fee schedule, covered services, or billing requirements for this service.
  3. Compare the payment with the contract terms. If it matches, post the adjustment as contractual.
  4. If it doesn’t match, contact provider relations or file a payment dispute with the contract terms attached.
  5. Don’t transfer the adjusted amount to the patient unless the contract allows it.

If N381 appears on many claims for one service, the contract may be pricing it differently from what you expect, which is worth reviewing at renewal.

Codes that may appear with N381

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge exceeds the contracted fee arrangement, the most common adjustment behind a contract reference.
  • CO-256 (Service not payable per managed care contract.): The service is not payable under the managed care contract.
  • CO-131 (Claim specific negotiated discount.): A claim-specific negotiated discount was applied.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to the patient's plan benefit documents rather than your provider contract.
  • N364 (Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.): An alert that your agreement requires waiving deductible or coinsurance.
  • N59 (Alert: Please refer to your provider manual for additional program and provider information.): Refers you to the provider manual for program information.

N381 FAQ

Can I appeal an adjustment with N381?

If the payment doesn't match your contract terms, yes. Include the contract section and rate that supports your position.

Can I bill the patient for the adjusted amount?

Usually not. Contractual adjustments reported under CO are the provider's responsibility.

What if I don't have a copy of my contract?

Request it from the payer's provider relations team. Keep current fee schedules and amendments on file.