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N454 Remark Code: Incomplete Consultation Report

N454 means the consultation report was incomplete or invalid. The payer received a report from the consulting provider, but it was missing required elements, unsigned, for the wrong encounter, or otherwise not usable to support the service.

Code: N454 (RARC N454)
Status: Active In use since July 1, 2008.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: CO (Contractual Obligation): The consultant needs to provide a complete report before the payer will pay. The amount is not billed to the patient.
Official description: Incomplete/invalid Consultation Report.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N454 means

With N454 the consultation report reached the payer, but it did not pass review. The paired code is usually CARC 251, and sometimes a level-of-service code like CARC 150 when the report did not support what was billed.

Elements reviewers expect

Element	What goes wrong
Requesting provider and reason	Not stated, so the visit reads like a routine visit
Consultant’s findings	Missing exam or history content
Opinion and recommendations	Absent or unclear
Communication back	No evidence the report went to the requesting provider
Signature and date	Unsigned, or signed long after the service
Patient and date of service	Wrong encounter or mismatched date

Payers vary in which of these they require, but gaps in the first three rows are the most common reason a consultation report is rejected.

How to fix it

Ask the payer which element failed if the notice does not say.
Review the report against the table, and gather any related documents such as the written request from the referring provider.
Add a dated addendum through the consultant if clarification is needed and supported by what actually happened.
Reconsider the code. If the documentation shows a regular visit rather than a consultation, correct the claim with resubmission code 7 and bill the appropriate service.
Resend with a cover sheet that references the claim number.

How to prevent it

Build consultation templates that prompt for the requesting provider, the question asked, findings, and recommendations, and require a signature before the claim releases.

Codes that may appear with N454

CO-251 (The attachment/other documentation that was received was incomplete or deficient.): The attachment received was incomplete or deficient.
CO-150 (Payer deems the information submitted does not support this level of service.): The information submitted does not support the level of service billed.

N453 (Missing Consultation Report.): The consultation report was not received at all.
N394 (Incomplete/invalid progress notes/report.): Progress notes or report were incomplete or invalid.
CO-B12 (Services not documented in patient's medical records.): Services were not documented in the medical record.

N454 FAQ

What is the most common reason for N454?

A report that does not show who requested the consultation or what the question was, or one without the consultant's signature. Both undermine the service as a consultation.

Should I rewrite the report?

No. The consultant can add a dated addendum to clarify, but the original report should not be altered.

What if the report is fine and the payer is wrong?

Resubmit with a cover letter pointing to the section that contains each required element, or appeal if the payer still disagrees.

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