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N441 Remark Code: Missed Appointment Not Covered

N441 means the missed or cancelled appointment is not covered. The claim billed for a visit the patient did not attend, and health plans generally do not pay for appointments where no service was provided.

Quick facts

Code
N441 (RARC N441)
Status
Active In use since July 1, 2008; last modified July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The plan does not pay missed-appointment charges. Whether the patient can be charged depends on your policy, your contract, and program rules.
  • CO (Contractual Obligation): When reported as contractual, the provider writes off the charge and should not bill the patient for it.
Official description
This missed/cancelled appointment is not covered.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N441 means

Insurance pays for services delivered. A missed or late-cancelled appointment has no service, so it has nothing for the plan to cover. N441 tells you the claim included a charge for a missed or cancelled appointment and the payer will not pay it. It is usually paired with CARC 96 (non-covered charge).

Common causes

  • A practice’s missed-appointment fee was set up as a billable charge and routed to insurance automatically.
  • The visit was scheduled and charged in advance, then cancelled, and the charge was never reversed.
  • The patient left before being seen, but the visit was still billed.
  • A telehealth session failed to connect, and the scheduled visit was billed anyway.

What to do

  1. Confirm no service happened. If the patient was actually seen, even briefly, review the documentation and bill the appropriate service instead.
  2. Reverse the insurance charge if it was a missed-appointment fee sent in error.
  3. Apply your missed-appointment policy directly to the patient only where program rules and contracts allow it. Make sure the policy was disclosed to the patient in advance.
  4. Stop the charge from routing to payers by setting up no-show fees as patient-only items in your system.

How to prevent it

Keep missed-appointment fees out of the insurance billing path entirely. Have a written policy that patients acknowledge, apply it consistently, and exclude groups for whom such fees are prohibited. Reviewing the day’s schedule against charges before claims go out helps catch visits that were cancelled but still charged.

Codes that may appear with N441

  • CO-96 (Non-covered charge(s).): Non-covered charge; N441 identifies it as a missed or cancelled appointment.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service is not covered under the patient's current benefit plan.
  • CO-115 (Procedure postponed, canceled, or delayed.): The procedure was postponed, canceled, or delayed.
  • N397 (Benefits are not available for incomplete service(s)/undelivered item(s).): Benefits are not available for incomplete services or undelivered items.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Consult plan benefit documents for restrictions on the service.

N441 FAQ

Can I charge a Medicaid patient a no-show fee?

It depends on the state. Missed appointments cannot be billed to Medicaid, and many state Medicaid programs also restrict charging beneficiaries for them. Check your state's Medicaid rules and your managed care contracts before charging any fee.

What about Medicare patients?

Medicare does not pay for missed appointments. Providers may generally charge Medicare patients a missed-appointment fee if the same policy applies to all patients, but the charge is billed directly to the patient, not to Medicare.

Should missed appointments be submitted to insurance at all?

Usually not. Many practices bill no-show fees directly to the patient under a written policy. Submitting them can create denials that clutter your A/R.