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N386 Remark Code: Decision Based on Medicare NCD

N386 means the payer based its decision on a National Coverage Determination (NCD), a national Medicare policy on whether a particular item or service is covered. You can find the policy in the Medicare Coverage Database on CMS.gov.

Quick facts

Code
N386 (RARC N386)
Status
Active In use since April 1, 2007; last modified March 1, 2026.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): When the NCD criteria weren't met and no valid advance notice was given, the denial is usually a provider liability.
  • PR (Patient Responsibility): If the patient signed a valid advance beneficiary notice before the service, the amount may be billed to the patient.
Official description
This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N386 means

National Coverage Determinations set Medicare’s nationwide rules for specific items and services: which conditions qualify, how often, in what setting, and with what documentation. N386 tells you the claim’s outcome came from one of those policies. It often means the service didn’t meet the NCD’s criteria as billed.

N386 frequently sits with CARC 50, 167, or 11, and sometimes CARC 96 when the NCD simply excludes the service.

Common causes

  • The diagnosis on the claim isn’t one the NCD lists as a covered indication.
  • The service was performed more often than the NCD allows.
  • The documentation requirements in the NCD weren’t met.
  • The diagnosis coding didn’t capture the condition that actually supports coverage.
  • The service is non-covered under the NCD for this situation.

What to do

  1. Find the NCD in the Medicare Coverage Database and read its covered indications, limitations, and any coding guidance.
  2. Compare the claim. Is the diagnosis a covered indication? Were frequency and documentation rules met?
  3. Correct coding errors if the record supports a covered diagnosis that wasn’t reported, and resubmit through the correct process.
  4. Appeal if you believe the service met the NCD, with records that tie the documentation to the criteria.
  5. Check for an ABN. If the service wasn’t covered and a valid advance notice was signed, the patient may be billed. Without one, the amount generally can’t be.

How to prevent it

Check NCD criteria before ordering services that have national policies, and give patients an advance beneficiary notice when coverage is doubtful. Claims Validator can flag diagnosis and procedure combinations that commonly fail coverage policies before submission.

Codes that may appear with N386

  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Not deemed medically necessary under the NCD's criteria.
  • CO-167 (This (these) diagnosis(es) is (are) not covered.): The diagnosis is not covered under the NCD.
  • CO-11 (The diagnosis is inconsistent with the procedure.): The diagnosis is inconsistent with the procedure.
  • CO-96 (Non-covered charge(s).): Non-covered charges, when the NCD excludes the service.
  • N115 (This decision was based on a Local Coverage Determination (LCD).): The local equivalent: the decision was based on a Local Coverage Determination (LCD).
  • N425 (Statutorily excluded service(s).): Used for services excluded by statute rather than by an NCD.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan benefit documents for restrictions on the service.

N386 FAQ

What is an NCD?

A National Coverage Determination is a Medicare policy that says whether, and under what conditions, an item or service is covered nationwide.

How do I find the NCD that applies?

Search the Medicare Coverage Database on CMS.gov by the service or keyword. The NCD lists covered indications, limitations, and sometimes the diagnosis codes that support coverage.

Do Medicare Advantage plans follow NCDs?

Medicare Advantage plans generally must follow NCDs, though they may apply their own processes. Check the plan's policy.