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N492 Remark Code: Member May Owe With Written Consent

N492 is an alert. It tells a network provider it may bill the member for this non-covered service only if the member requested it and agreed in writing, before receiving it, to pay the billed charge. Without that prior written agreement, the provider generally may not bill the member.

Quick facts

Code
N492 (RARC N492)
Status
Active In use since July 1, 2008.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The amount may be collected from the member, but only when the required advance written agreement exists.
  • CO (Contractual Obligation): Without the member's advance written agreement, the network provider generally absorbs the amount.
Official description
Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N492 means

Network contracts usually prevent providers from billing members for services the plan does not cover, unless certain conditions are met. N492 spells out the condition: the member asked for the service and agreed in writing, before it was provided, to pay the billed charge. It is the commercial-plan cousin of Medicare’s advance beneficiary notice rules.

The remark does not deny anything on its own. The denial comes from the paired reason code, often CARC 204 or CARC 96. N492 explains who may be responsible.

What to do

  1. Look for a signed agreement in the patient’s record dated before the service.
  2. If one exists and meets the plan’s requirements, you may bill the member according to its terms.
  3. If none exists, or it was signed late or is incomplete, write off the amount per your contract rather than billing the member.
  4. If you believe the service should be covered, appeal the denial on its merits instead of relying on the member agreement.

Plan requirements for these agreements differ, so check your provider manual. Using a consistent, plan-approved form at scheduling makes the difference between a collectible balance and a write-off.

Codes that may appear with N492

  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service is not covered under the member's current benefit plan.
  • CO-96 (Non-covered charge(s).): Non-covered charge; N492 explains when the member can be billed for it.
  • CO-50 (These are non-covered services because this is not deemed a 'medical necessity' by the payer.): Not medically necessary per the payer, a common situation for advance member agreements.
  • M38 (Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not…): Medicare's version: the patient is liable after being informed in writing before the service.
  • M39 (Alert: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with…): The patient is not liable because the advance notice did not meet requirements.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan documents for coverage limits on the service.

N492 FAQ

What must the written agreement include?

Requirements come from the plan and your network contract. At a minimum it is usually signed before the service, names the service, states that it is not covered, and shows the member agreed to pay. Some plans require their own form.

Can the agreement be signed after the visit?

N492 specifies prior to receiving the service. An agreement signed afterward generally does not meet that condition.

Does N492 change what the plan paid?

No. It is informational. The payment decision comes from the accompanying reason code.