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N470 Remark Code: Mandatory Reimbursement Limit Reached

N470 means this payment completes the mandatory medical reimbursement limit. On a workers' compensation or similar injury claim that the carrier has not accepted, the carrier has now paid the full amount it is required to pay before a compensability decision, so further bills will not be paid under that requirement.

Code: N470 (RARC N470)
Status: Active In use since July 1, 2008.
Code set: Remittance Advice Remark Codes (RARC)
Group codes: CO (Contractual Obligation): Charges beyond the limit are not paid by this carrier while the claim is pending. They are not a final write-off if the claim is later accepted.
OA (Other Adjustment): Some carriers report the unpaid remainder as an other adjustment pending the compensability decision.
Official description: This payment will complete the mandatory medical reimbursement limit.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What N470 means

Some workers’ compensation systems require carriers to pay for medical care up to a limit while they investigate whether an injury is work-related. N470 tells you the current payment reaches that limit. The carrier has met its obligation for the pending period, so later charges on the same injury will not be paid under that rule unless the claim is accepted.

It usually follows earlier remittances carrying N436, and may appear with CARC P8 or P13.

What changes after N470

New claims for the same injury will likely be denied or held while compensability is pending.
Balances need a plan: wait for the decision, bill a health plan if the rules allow, or discuss with the patient where permitted.
Timely filing still applies to every payer you may eventually bill.

What to do

Flag the account so staff know the mandatory reimbursement is exhausted.
Contact the adjuster for the status of the compensability decision and an expected timeline.
Check the patient’s other coverage and the jurisdiction’s rules on billing a health plan during a pending workers’ compensation claim.
Hold or redirect new charges according to those rules, keeping proof of each submission.
When a decision arrives, bill the carrier for the remaining charges if accepted, or move them to other coverage if denied.

How to prevent surprises

Track mandatory reimbursement totals on pending injury claims so you can see the limit coming, and talk with the patient about payment options before it is reached. Keep jurisdiction rules on file for each state you treat injured workers from.

Codes that may appear with N470

CO-P8 (Claim is under investigation.): The claim is under investigation.
CO-P13 (Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable.): Payment reduced or denied under workers' compensation jurisdictional rules or payment policies.
PR-119 (Benefit maximum for this time period or occurrence has been reached.): A benefit maximum was reached, here the mandatory reimbursement cap.

N436 (The injury claim has not been accepted and a mandatory medical reimbursement has been made.): The injury claim is not accepted, and a mandatory medical reimbursement has been made.
N437 (Alert: If the injury claim is accepted, these charges will be reconsidered.): An alert that charges will be reconsidered if the injury claim is accepted.
CO-P4 (Workers' Compensation claim adjudicated as non-compensable.): The workers' compensation claim was adjudicated as non-compensable.

N470 FAQ

What happens to bills after the limit?

The carrier generally will not pay them under the mandatory reimbursement rule. They may be paid if the claim is later accepted, or may need to go to the patient's health plan if it is denied.

How much is the limit?

It depends on the jurisdiction. Some states set a dollar cap or a time period for care paid while a claim is investigated. Check the rules for the state handling the claim.

Should I stop treating the patient?

Clinical decisions should not depend on this code. It affects who pays, not whether care is needed. Discuss payment options with the patient and continue coordinating with the carrier.

Important: read before using this information

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