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N449 Remark Code: Paid Based on Comparable Item

N449 means payment was based on a comparable drug, service, or supply. The payer did not price the item as billed and instead used the rate for something it considers comparable, which can lower the allowed amount.

Quick facts

Code
N449 (RARC N449)
Status
Active In use since July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The difference between your charge and the comparable item's rate is typically a contractual adjustment, not a patient balance.
  • PR (Patient Responsibility): Cost sharing is based on the comparable allowed amount, so the patient's share follows that rate.
Official description
Payment based on a comparable drug/service/supply.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N449 means

When a payer has no direct price for an item, or does not accept the code as billed, it may look for something similar that it does have a price for. N449 explains that the payment you received was calculated that way: the payer used a comparable drug, service, or supply as the pricing basis. It usually pairs with CARC 45, and with CARC P18 on workers’ compensation and other property and casualty claims.

Where it shows up

  • Unlisted procedures priced against a similar listed service.
  • Drugs priced at the rate for a similar product, including a different strength or formulation.
  • Supplies and equipment priced by reference to a similar item with an established fee.
  • Jurisdictional fee schedules that direct payers to use a comparable service when a code is missing.

How to review the payment

  1. Ask what the payer compared against, including the code or product and its rate.
  2. Compare it with what was provided. Look at complexity, time, resources, product cost, and clinical purpose.
  3. Check your own coding. If a more specific code exists, billing it may produce a direct price; submit a corrected claim with resubmission code 7 if the original code was not the best fit.
  4. Dispute with specifics if the comparable item undervalues the service. Include documentation such as operative notes, invoices, or a side-by-side comparison.
  5. Accept the payment if the comparison is reasonable.

How to prevent low comparable pricing

For unlisted services, send a clear description and a suggested comparable code with the claim, so the payer starts from a sensible benchmark rather than its own choice. Track which items repeatedly price by comparison and address them in contract discussions.

Codes that may appear with N449

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge exceeds the allowed amount, which was set using a comparable item.
  • CO-P18 (Procedure is not listed in the jurisdiction fee schedule.): The procedure is not in the jurisdiction fee schedule, and an allowance was made for a comparable service.
  • CO-169 (Alternate benefit has been provided.): An alternate benefit has been provided.
  • N448 (This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.): The item is not in the fee schedule or contracted fee arrangement.
  • N447 (Payment is based on a generic equivalent as required documentation was not provided.): Payment based on a generic equivalent because brand documentation was missing.
  • N442 (Payment based on an alternate fee schedule.): Payment based on an alternate fee schedule.

N449 FAQ

How does the payer choose a comparable item?

It depends on the payer. It may use a similar code, a similar product, or a service with comparable resources. Ask the payer which comparison it used.

Is N449 a denial?

No. The claim was paid; the remark explains the basis for the amount.

When is it worth disputing?

When the comparable item clearly differs from what was provided in cost, complexity, or function, and you can document the difference.