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N398 Remark Code: Missing Elective Consent Form

N398 means the payer requires a signed consent form for this elective procedure, and the form was not received with the claim or in response to its request.

Quick facts

Code
N398 (RARC N398)
Status
Active In use since August 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim is denied until a valid consent form is on file. The provider is responsible; the patient is not billed for this adjustment.
Official description
Missing elective consent form.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N398 means

Some elective procedures carry a payer requirement for documented, informed consent, sometimes on a specific form with specific timing. N398 tells you the payer has no consent form on file for this procedure, so it won’t pay.

It usually appears with CARC 252 or CARC 163.

Common causes

  • The form was signed and kept in the chart but never sent to the payer.
  • The surgeon’s office sent the form with its claim, but the facility or anesthesia provider didn’t.
  • The form was sent separately without the claim number or patient identifiers and wasn’t matched.
  • The practice used a general surgical consent when the payer requires its own or a program-specific form.
  • No consent form was obtained.

What to do

  1. Check the payer’s requirement. Which form, who signs, and any timing rules between signing and the procedure.
  2. Locate the signed form in the chart or request a copy from the surgeon’s office if you’re the facility or anesthesia provider.
  3. Verify it meets the rules. Right form version, all signatures, and dates that satisfy any waiting period.
  4. Submit it as an attachment with the claim number, using the payer’s attachment method.
  5. If no valid form exists, confirm whether the requirement can be met at all. For programs with waiting periods, it usually cannot be fixed after the procedure.

How to prevent it

Build a pre-surgery checklist that confirms the correct consent form is signed, dated within any required window, and copied to every billing party. Attach the form to the claim when it goes out for payers known to require it.

Codes that may appear with N398

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): An attachment is required; N398 identifies the elective consent form.
  • CO-163 (Attachment/other documentation referenced on the claim was not received.): The attachment referenced on the claim was not received.
  • N399 (Incomplete/invalid elective consent form.): Used when the elective consent form was received but is incomplete or invalid.
  • N3 (Missing consent form.): Covers a missing consent form in general.
  • N28 (Consent form requirements not fulfilled.): Says consent form requirements were not fulfilled.

N398 FAQ

Which procedures need a consent form for payment?

It depends on the payer. A well-known example is sterilization under Medicaid, which requires a specific consent form signed within set time limits. Other payers may require consent for particular elective procedures.

Can the patient sign the form after the procedure?

For some programs, no. Certain consent forms must be signed a minimum time before the procedure, so a late signature does not fix the claim.

Do all providers on the case need the form?

Often yes. Payers may require a copy with the surgeon's, anesthesia, and facility claims. Share the signed form with everyone billing for the procedure.