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N567 Remark Code: Not Covered as Preventive Care

N567 means the payer denied the service because it was considered preventive, and the patient's plan does not cover it in that context. Whether the charge can be billed to the patient depends on the group code and the plan.

Quick facts

Code
N567 (RARC N567)
Status
Active In use since March 1, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The plan excludes the preventive service, and the patient may be responsible. Check the plan terms and any notice requirements first.
  • CO (Contractual Obligation): The provider is responsible, for example because a contract prevents billing the patient or no required waiver was obtained.
Official description
Not covered when considered preventative.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N567 means

Payers treat the same service differently depending on why it was done. A screening performed on a patient without symptoms is preventive; the same test ordered because of symptoms is diagnostic. N567 says the payer classified your service as preventive, and the patient’s plan does not cover it on that basis.

It typically accompanies CARC 49 (routine or preventive services not covered), CARC 204 (not covered under the current plan), or CARC 96 (non-covered charge).

Common causes

  • The plan excludes that preventive service, or covers it only at certain intervals or ages.
  • The diagnosis codes point to screening (for example, a Z-code encounter for screening) even though the visit addressed a problem.
  • A preventive-visit modifier or code choice told the payer the service was routine.
  • Frequency limits for the preventive benefit were already used.

How to fix it

  1. Review the documentation. Was the service truly preventive, or was there a clinical reason?
  2. If coding was wrong, submit a corrected claim with diagnosis codes that reflect the clinical reason, using resubmission code 7 in box 22.
  3. If coding was right, check the group code. With PR, follow your financial policy for patient billing. With CO, write off or appeal if you believe the plan covers the service.
  4. Appeal with medical records if the plan’s benefit terms support coverage.

How to prevent it

Verify preventive benefits and frequency limits before scheduling, and make sure diagnosis selection reflects why each service was performed. When a service may not be covered, discuss cost with the patient in advance. See eligibility and COB denials for benefit verification practices.

Codes that may appear with N567

  • CO-49 (This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a…): A routine or preventive exam or screening is not covered; N567 confirms the preventive classification drove the denial.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service is not covered under the patient's current benefit plan.
  • CO-96 (Non-covered charge(s).): A non-covered charge, with N567 explaining the reason.
  • N429 (Not covered when considered routine.): Not covered when considered routine, a closely related wording.
  • N569 (Not covered when performed for the reported diagnosis.): Not covered for the reported diagnosis.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Directs you to the plan's benefit documents for restrictions.

N567 FAQ

Doesn't the ACA require preventive care coverage?

Many plans must cover certain preventive services, but not all plans are subject to that rule and not every service is included. Plan type, grandfathered status, and network use all matter, so check the patient's benefits.

What if the service was diagnostic, not preventive?

If the patient had symptoms or a known condition that prompted the service, the documentation and diagnosis codes should show that. Correct the coding if it was wrong, or appeal with the records.

Can I bill the patient?

Only when the group code is PR and your contract and applicable rules allow it.