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N473 Remark Code: Missing Certification

N473 means a required certification is missing. The payer needs a certification, typically a practitioner's signed statement confirming the patient's need for a service, item, or level of care, and did not receive it.

Quick facts

Code
N473 (RARC N473)
Status
Active In use since July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim is held or denied until the certification is received. The provider obtains it; the patient is not billed.
Official description
Missing certification.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N473 means

A certification is a formal statement, signed by a practitioner, that a patient needs a particular service, item, or level of care. Many payers make payment conditional on having one. N473 says the certification the payer requires for this claim was not received.

The remark is generic, so the certification in question depends on the service. It usually appears with CARC 252 or CARC 16.

Examples of certifications payers require

  • Equipment and supplies: a certificate of medical necessity or similar form for certain items.
  • Home health: a physician’s certification that the patient is homebound and needs skilled services under a plan of care.
  • Hospice: certification of terminal illness.
  • Inpatient or specialized care: certifications of need for particular stays or programs.
  • Therapy: certification of the plan of care, which has its own remark code (N485).

What to do

  1. Identify the certification the payer expects for this service and date, from its request or policy.
  2. Check the record for a signed, dated certification covering the dates of service.
  3. Obtain it from the certifying practitioner if missing, and confirm any prerequisite, such as a documented face-to-face visit, was met.
  4. Submit it through the payer’s channel with the claim number, or file a corrected claim with resubmission code 7 if the payer requires certification data on the claim.
  5. Appeal if a valid certification existed on time and the payer overlooked it.

How to prevent it

Build certification requirements into intake for each service line, and do not start care that requires certification until you have it or a clear plan to obtain it. Track recertification dates for ongoing services.

Codes that may appear with N473

  • CO-252 (An attachment/other documentation is required to adjudicate this claim/service.): Documentation is required; N473 specifies the certification.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): The claim lacks information needed for adjudication.
  • CO-272 (Coverage/program guidelines were not met.): Coverage or program guidelines were not met, which can include a certification requirement.
  • N474 (Incomplete/invalid certification.): The certification was received but was incomplete or invalid.
  • N485 (Missing Physical Therapy Certification.): The physical therapy certification specifically is missing.
  • N403 (Missing facility certification.): A facility certification, rather than a patient-level certification, is missing.

N473 FAQ

Which certification does N473 mean?

The code is general. Common examples are certificates of medical necessity for equipment, physician certifications for home health or hospice, and certifications of need for certain inpatient or therapy services. The payer's request or policy will say which.

Who signs a certification?

Usually the treating physician or another practitioner the payer allows. Some certifications require a face-to-face encounter first.

Can a certification be signed after the service?

Some payers allow delayed certification with an explanation, while others require it before or at the start of care. Check the specific rule.