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N427 Remark Code: Eyewear Only After Cataract Surgery

N427 means payment for eyeglasses or contact lenses can be made only after cataract surgery. The payer either found no qualifying cataract surgery or could not connect the eyewear on the claim to one.

Quick facts

Code
N427 (RARC N427)
Status
Active In use since August 1, 2007.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): If the patient has not had qualifying cataract surgery, the eyewear is not covered and may be billed to the patient with proper notice.
  • CO (Contractual Obligation): When reported as contractual, the supplier absorbs the charge unless the patient was notified in advance as the payer requires.
Official description
Payment for eyeglasses or contact lenses can be made only after cataract surgery.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N427 means

For many medical plans, especially Medicare, eyeglasses and contact lenses are not a routine benefit. The exception is eyewear needed after cataract surgery, and N427 says that exception was not established for this claim. The payer is not saying the glasses were unnecessary; it is saying the qualifying event, the cataract surgery, was not found or not linked.

Expect N427 alongside CARC 96 (non-covered charge) or a qualifying-service code such as CARC B15.

Common causes

  • No surgery on record. The patient never had cataract surgery, and routine eyewear was billed to the medical plan.
  • Missing link. The claim did not include the diagnosis showing the patient’s post-cataract status, or it omitted details the payer uses to connect the eyewear to the surgery.
  • Surgery billed under another payer. The surgery happened while the patient had different coverage, so this payer’s history does not show it.
  • Eyewear dispensed before surgery, or for the wrong eye.
  • A prior post-surgery pair was already covered, and a second pair was billed.

How to fix it

  1. Confirm the surgery date and eye from the surgeon’s operative report or records.
  2. Check the diagnosis codes on the eyewear claim. They should reflect the patient’s post-cataract condition as the payer’s policy requires.
  3. Add any missing modifiers or dates that the payer uses to identify the eye and surgery, and send a corrected claim with resubmission code 7.
  4. If the surgery was paid by a different insurer, send the payer documentation of the surgery and ask for reconsideration.
  5. If no qualifying surgery exists, bill the patient’s vision plan if they have one, or bill the patient under your notice procedures.

How to prevent it

At the dispensing visit, record the cataract surgery date, eye, and surgeon, and keep the operative report on file. Train staff to separate routine eyewear sales from post-cataract eyewear, since the two go to different payers or benefits. Checking the claim for the right diagnosis and eye modifiers before it goes out is the single biggest safeguard.

Codes that may appear with N427

  • CO-96 (Non-covered charge(s).): Non-covered charge; N427 explains the eyewear is covered only following cataract surgery.
  • CO-B15 (This service/procedure requires that a qualifying service/procedure be received and covered.): The service requires a qualifying service that was not received or covered, here the cataract surgery.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Used when information linking the eyewear to the surgery, such as the surgery date or diagnosis, is missing.
  • N410 (Not covered unless the prescription changes.): Another vision restriction: replacement eyewear not covered unless the prescription changes.
  • N319 (Missing/incomplete/invalid hearing or vision prescription date.): A missing or invalid vision prescription date.
  • M86 (Service denied because payment already made for same/similar procedure within set time frame.): The same or similar item was already paid within a set time frame, such as a prior pair after the same surgery.

N427 FAQ

Does Medicare cover glasses after cataract surgery?

Medicare generally covers one pair of eyeglasses or one set of contact lenses after each cataract surgery that implants an intraocular lens. Routine eyewear outside that situation is not covered.

What if the patient had surgery on both eyes?

Coverage rules for surgery on each eye vary by program. Document the dates of each surgery and check the payer's policy on how many pairs are allowed and when.

Can a supplier bill the patient after N427?

If the eyewear does not qualify, the patient is often responsible, but notice rules apply. For Medicare, suppliers should understand when an advance beneficiary notice is appropriate.