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N43 Remark Code: Bed Hold or Leave Days Exceeded

N43 means the bed hold or leave days billed exceed what the payer allows. Facilities such as nursing homes can be paid to hold a resident's bed during a hospital stay or therapeutic leave, but only up to a limit set by the payer or program.

Quick facts

Code
N43 (RARC N43)
Status
Active In use since January 1, 2000.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): Days beyond the limit are a facility write-off under the payer's rules. Whether the resident can be charged depends on program rules and the admission agreement.
  • PR (Patient Responsibility): The payer assigned excess days to the resident, which may be permissible if the resident or family agreed in advance to pay for the bed hold.
Official description
Bed hold or leave days exceeded.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N43 means

Long-term care facilities sometimes bill for days when the resident is absent, so the resident’s bed is kept available when they come back. Payers that cover those days usually limit how many are allowed per year, per stay, or per absence. N43 says the claim included more of those days than the payer’s rule allows.

The excess days are typically adjusted with CARC 78 (non-covered days/room charge), CARC 119, or CARC 273.

Common causes

  • The resident’s hospital stay lasted longer than the bed hold limit.
  • Multiple leaves during the year used up the annual allowance.
  • Hospital and therapeutic leave days were combined in a way that exceeded a combined cap.
  • Leave days were coded with a leave-of-absence revenue code but the payer counted them against a different benefit.
  • The facility’s leave tracking did not match the payer’s count.

What to do

  1. Recount the leave days in the resident’s record for the period the payer measures.
  2. Compare to the payer’s policy, including how it counts partial days and the day of departure or return.
  3. Correct and rebill if leave days were miscounted or coded incorrectly, using a corrected institutional claim.
  4. Appeal if your count is within the limit and you can document the dates.
  5. Bill the resident only if permitted by program rules and a signed agreement.

How to prevent it

Track leave days in real time against each payer’s limits, and alert social services and the business office as a resident approaches the cap. Discuss bed hold options and costs with residents and families before a planned leave or as soon as a hospital stay extends.

Codes that may appear with N43

  • CO-78 (Non-Covered days/Room charge adjustment.): Non-covered days or room charge adjustment, reflecting the excess days.
  • PR-119 (Benefit maximum for this time period or occurrence has been reached.): The benefit maximum for the time period has been reached.
  • CO-273 (Coverage/program guidelines were exceeded.): Coverage or program guidelines were exceeded.
  • N153 (Missing/incomplete/invalid room and board rate.): The room and board rate is missing, incomplete, or invalid.
  • N47 (Claim conflicts with another inpatient stay.): The claim conflicts with another inpatient stay, a possible overlap with a hospital admission.
  • N141 (The patient was not residing in a long-term care facility during all or part of the service dates billed.): The patient was not residing in a long-term care facility for all or part of the dates billed.

N43 FAQ

What is the difference between bed hold and leave days?

Bed hold days usually refer to reserving the bed while a resident is hospitalized. Therapeutic or home leave days cover planned absences such as family visits. Programs may count them separately or together.

Do Medicaid programs all have the same limits?

No. Each state sets its own bed hold and leave policies, and some do not pay for bed holds at all. Other payers set their own terms.

Can the facility charge the family for extra days?

It may be allowed if the resident or family agreed in writing to pay privately for days beyond the limit and the program permits it. Check state rules and your admission agreement.