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N592 Remark Code: Not the Initial Prescription

N592 means the payer adjusted the charge because the prescription is not the initial prescription, or because it exceeds the quantity or amount allowed for an initial prescription. Some programs pay differently for first fills than for refills.

Quick facts

Code
N592 (RARC N592)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The reduction follows the payer's initial-prescription rules. The dispensing provider generally absorbs it.
  • PR (Patient Responsibility): Where rules allow, the patient may owe the amount above the permitted initial supply.
Official description
Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N592 means

Some payers, particularly workers’ compensation programs, set special limits on the first prescription for an injury, such as a maximum day supply or quantity, and apply different rules to later fills. N592 tells you one of two things happened: the prescription was treated as a refill rather than an initial fill, or the initial fill exceeded what is allowed.

Common companions are CARC 154 (day supply not supported), CARC 153 (dosage not supported), and P13 (jurisdictional rules).

Common causes

  • The quantity or day supply on the initial prescription exceeded the limit.
  • The prescription was billed as initial when an earlier fill already exists for the same drug and injury.
  • Physician dispensing rules limit what can be dispensed from the office.
  • A drug formulary requires authorization after the initial supply.

How to fix it

  1. Check the payer’s or jurisdiction’s pharmacy rules for initial and subsequent fills.
  2. Review the prescription history for this injury to see whether an earlier fill exists.
  3. Correct the bill if the fill number, quantity, or day supply was wrong.
  4. Request authorization when a larger supply or continued therapy is clinically needed, and submit the prescriber’s justification.
  5. Dispute through the program’s process if you believe the rule was misapplied.

How to prevent it

Load initial-fill limits for your injury payers into your dispensing or billing workflow, and check prescription history before dispensing.

Codes that may appear with N592

  • CO-154 (Payer deems the information submitted does not support this day's supply.): The information submitted does not support this day's supply.
  • CO-153 (Payer deems the information submitted does not support this dosage.): The information submitted does not support this dosage.
  • CO-P13 (Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable.): Reduced under workers' compensation jurisdictional rules or payment policy.
  • N378 (Missing/incomplete/invalid prescription quantity.): The prescription quantity is missing or invalid.
  • N602 (Adjusted based on the Redbook maximum allowance.): Adjusted based on the Redbook maximum allowance for drugs.
  • N640 (Exceeds number/frequency approved/allowed within time period.): Exceeds the number or frequency allowed within a time period.

N592 FAQ

Why would a payer limit initial prescriptions?

Some workers' compensation and injury programs restrict the first fill, for example for opioids or when a provider dispenses in the office, and require review before larger or continued supplies.

Is a refill ever paid under N592?

N592 means the payer treated it differently because it is not the first fill. Refills may still be payable under different rules or after authorization.

How do I correct the quantity?

If the quantity was billed wrong, submit a corrected bill. If it was right, request authorization for the larger supply or dispute the reduction.