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N428 Remark Code: Not Covered in This Place of Service

N428 means the service is not covered when performed in the place of service reported on the claim. Either the POS code is wrong, or the payer does not pay for this service in that setting.

Quick facts

Code
N428 (RARC N428)
Status
Active In use since August 1, 2007; last modified March 8, 2011.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Most N428 denials are provider adjustments: the setting or the POS code does not meet payer rules, and the patient is not billed unless properly notified.
  • PR (Patient Responsibility): If the patient chose a setting the plan does not cover after being told, some payers and contracts allow billing the patient.
Official description
Not covered when performed in this place of service.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N428 means

Every professional claim line carries a place of service (POS) code telling the payer where the service happened: office, hospital outpatient, inpatient, home, skilled nursing facility, telehealth, and so on. N428 says the payer will not cover this service in the setting reported. It most often supports CARC 58 or CARC 5.

The first question is whether the POS code is accurate. The second is whether the payer covers the service in that setting at all.

Common causes

  • Wrong POS code. A facility-based service was billed with the office code, or an office service with a hospital code.
  • Default POS in the billing system applied to every line, even when a service happened elsewhere.
  • Setting restriction in payer policy. Some services are covered only in certain settings, such as a facility rather than the office, or only outside the home.
  • Telehealth POS mismatch with the payer’s current rules.
  • Inpatient status. A service billed with an outpatient POS while the patient was an inpatient, or the reverse.

How to fix it

  1. Verify the actual location of service from the medical record, including the patient’s status (inpatient, outpatient, observation) on that date.
  2. Compare it with box 24B or the POS on the electronic claim, line by line.
  3. If the POS was wrong, correct it and send a corrected claim with resubmission code 7 and the original claim number.
  4. If the POS was right, read the payer’s coverage policy for the service. If the setting is excluded, the denial is likely valid.
  5. Appeal when the policy allows the setting under conditions you met, attaching documentation that shows why the setting was necessary.

How to prevent it

Pull POS from the scheduled location rather than a single system default, and have facility-based services flagged at charge entry. Claims Validator can flag POS values that don’t fit the rest of the claim before it goes out.

Codes that may appear with N428

  • CO-58 (Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.): Treatment was deemed rendered in an inappropriate or invalid place of service.
  • CO-5 (The procedure code/type of bill is inconsistent with the place of service.): The procedure code or bill type is inconsistent with the place of service.
  • CO-96 (Non-covered charge(s).): Non-covered charge; N428 names the place of service as the reason.
  • M77 (Missing/incomplete/invalid/inappropriate place of service.): The place of service is missing, incomplete, invalid, or inappropriate, a data error rather than a coverage rule.
  • CO-171 (Payment is denied when performed/billed by this type of provider in this type of facility.): Denied when performed by this type of provider in this type of facility.
  • N95 (This provider type/provider specialty may not bill this service.): The provider type or specialty may not bill the service.

N428 FAQ

Where is the place of service reported?

On a CMS-1500 it goes in box 24B for each service line. On electronic professional claims it is reported at the claim level, with line-level overrides when a line differs.

Is N428 always a coding error?

No. Sometimes the POS is correct and the payer simply does not cover the service in that setting. Check the payer's policy before changing anything.

What about telehealth?

Telehealth services often require specific POS codes and modifiers that vary by payer and over time. If a virtual visit denies with N428, confirm the payer's current telehealth billing rules.