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N413 Remark Code: Allowed Twice Per Benefit Year

N413 means the plan allows this service two times in a benefit year. The patient has already used both allowed services in the current benefit year, so the payer denied or reduced this claim.

Quick facts

Code
N413 (RARC N413)
Status
Active In use since August 1, 2007; last modified July 1, 2016.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The benefit allowance is used up for the year, so the patient may be responsible if properly informed and your contract permits billing.
  • CO (Contractual Obligation): When the payer applies the limit under provider contract terms, the amount is written off rather than billed to the patient.
Official description
This service is allowed 2 times in a benefit year.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N413 means

N413 ties the frequency limit to the benefit year. The patient gets two of this service per benefit year, and the payer’s records show both have been used. Any additional service before the benefit year renews is outside the allowance. Expect to see it paired with CARC 119 (benefit maximum reached) or CARC 273 (coverage guidelines exceeded).

The key distinction from rolling limits is the reset. Once the new benefit year starts, the count goes back to zero regardless of how recently the last service happened.

Common causes

  • Wrong assumption about the benefit year. The office assumed a calendar year, but the plan renews in July or another month, so a “new year” service still counted against the old allowance.
  • Services at other providers already used one or both allowed services.
  • An earlier claim posted to the wrong date, placing it in the current benefit year.
  • Duplicate billing of an earlier service that inflated the count.

How to fix it

  1. Confirm the benefit year dates from an eligibility check or the payer’s portal.
  2. Ask which prior services were counted, including dates and billing providers.
  3. Correct any bad data. If a prior service’s date was wrong, have that claim corrected, then request reprocessing of this one. If the current claim’s date was wrong, send a corrected claim with resubmission code 7.
  4. Look for an exception process if the extra service was medically necessary, and appeal with the clinical documentation.
  5. Bill the patient only when the denial is valid and your contract and notice practices permit it.

How to prevent it

Record each patient’s benefit year dates at intake, not just the calendar year. When a patient asks for the service late in the benefit year, check how many have been used first. Where a new benefit year is close, offering a date after renewal can avoid the denial entirely.

Codes that may appear with N413

  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): The benefit maximum for the time period was reached; the period in N413 is the benefit year.
  • CO-273 (Coverage/program guidelines were exceeded.): Coverage guidelines were exceeded; N413 gives the specific twice-per-year rule.
  • N412 (This service is allowed 2 times in a 12-month period.): The same count of two, but measured over a rolling 12 months rather than the benefit year.
  • N411 (This service is allowed one time in a 6-month period.): A limit of one service every six months.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Tells you to consult the plan's benefit documents for restrictions on the service.

N413 FAQ

Is a benefit year the same as a calendar year?

Sometimes. Many plans run January through December, but others renew on a different date. The benefit year is defined in the plan documents and is often shown on eligibility responses.

When does the count reset?

On the first day of the new benefit year. A service on that date or later starts a fresh count of two, even if the last one was only weeks earlier.

What if the patient changed plans mid-year?

Services billed to the old plan generally do not count against the new one, but some plans administered by the same carrier may track them together. Ask the payer how it applies the limit.