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N414 Remark Code: Allowed 4 Times in 12 Months

N414 means the service is allowed four times in a 12-month period. The payer counted four prior allowed services within that time frame, so the service on this claim went over the limit and was denied or reduced.

Quick facts

Code
N414 (RARC N414)
Status
Active In use since August 1, 2007; last modified July 1, 2016.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The frequency cap is applied under payer policy or contract, so the over-limit amount is a provider adjustment.
  • PR (Patient Responsibility): The patient's benefit allowance is exhausted for the period, and the patient may owe the charge if notified in advance.
Official description
This service is allowed 4 times in a 12-month period.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N414 means

N414 appears when a patient reaches a four-service cap. The payer allows the billed service four times within a 12-month period, and this claim represents at least the fifth. It commonly accompanies CARC 119 or CARC 151.

Limits of this size tend to apply to services repeated throughout the year for monitoring or ongoing management. Because the allowance is larger than a once- or twice-a-year limit, offices often stop tracking it, and that is where denials start.

Common causes

  • Unscheduled extra visits. A patient on a regular schedule needed an additional service mid-year, and that extra one used up the cap before the final scheduled service.
  • Care split across providers. Another clinic, lab, or facility billed some of the four.
  • Counting method mismatch. Your office counted by calendar year while the payer used a 12-month period.
  • Incorrect prior data. A duplicate or wrongly dated earlier claim was counted against the limit.

How to fix it

  1. List every service the payer counted. Ask for dates and billing providers if the remittance does not show them.
  2. Match that list to your records and to any history the patient reports from other providers.
  3. Challenge any errors. If a counted service was a duplicate or had the wrong date, get that claim corrected and ask for reprocessing of the denied line.
  4. Submit an exception or appeal when the additional service was clinically necessary. A short letter explaining why, plus supporting notes, is more persuasive than records alone.
  5. Accept valid denials and handle the balance under your contract and any notice given to the patient.

How to prevent it

Keep a running count per patient for services that carry a frequency cap, and include services the patient received elsewhere when you know about them. Before booking a fourth or fifth service in 12 months, check the count and, where the plan allows, request an exception in advance.

Codes that may appear with N414

  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): The benefit maximum for the time period has been reached; N414 identifies the cap as four per 12 months.
  • CO-151 (Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.): The information submitted does not support this many services.
  • CO-273 (Coverage/program guidelines were exceeded.): Coverage or program guidelines were exceeded.
  • N412 (This service is allowed 2 times in a 12-month period.): A tighter limit of two services per 12 months.
  • N435 (Exceeds number/frequency approved /allowed within time period without support documentation.): The frequency was exceeded without supporting documentation, which suggests more services may be payable with records.
  • M86 (Service denied because payment already made for same/similar procedure within set time frame.): Payment was already made for the same or similar service within a set time frame.

N414 FAQ

Is four in 12 months the same as once a quarter?

Not exactly. A quarterly schedule may fit, but the payer is counting services inside a 12-month period, not calendar quarters. Two services close together can use up the allowance early.

Can the payer count services from a hospital or another clinic?

Yes, if they were billed under the same service and patient. Frequency limits are usually tracked per member, so all allowed claims can count.

Is there any way to get a fifth service paid?

Some payers accept documentation of medical necessity through an exception or appeal. Others treat the limit as absolute. Check the payer's policy before submitting a request.