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N593 Remark Code: Patient Missed Scheduled IME

N593 means the payer denied coverage because the patient failed to attend a scheduled independent medical examination (IME). Many auto and workers' compensation policies make attendance a condition of continued benefits.

Quick facts

Code
N593 (RARC N593)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • OA (Other Adjustment): Benefits were cut off because of the patient's non-attendance. The amount may become payable if the IME is rescheduled and completed.
  • PR (Patient Responsibility): Some carriers assign the amount to the patient. Check state law before billing, especially for no-fault claims.
Official description
Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N593 means

When an injury insurer schedules an independent medical exam, the patient is usually required to attend. N593 tells you the patient did not show up, and the insurer has denied coverage as a result. Unlike N590, where the report is simply not available, N593 names the patient’s absence as the reason.

It generally appears with CARC 227, P6, or P21.

Common causes

  • The patient did not receive the notice, often because of an old address.
  • The patient could not get to the exam or had a scheduling conflict.
  • The patient’s attorney advised against attending while disputing the request.
  • The patient didn’t understand the exam was mandatory.

What to do

  1. Ask the adjuster which dates of service are affected and whether the exam can be rescheduled.
  2. Contact the patient right away and explain that their benefits depend on attending.
  3. Pause non-urgent treatment billing to that carrier until coverage is restored, and document your conversations.
  4. Request reprocessing after the rescheduled IME is completed, if the carrier reinstates benefits.
  5. Look at other coverage if the denial stands, checking state rules on billing the patient.

How to prevent it

Tell injury patients at intake that insurers may require an IME and that missing one can stop payment. Keep contact information current so insurer notices reach them.

Codes that may appear with N593

  • CO-227 (Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete.): Information or participation required from the patient was not provided.
  • CO-P6 (Based on entitlement to benefits.): Denied based on entitlement to benefits.
  • CO-P21 (Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP)): Denied under PIP or medical payments rules.
  • N590 (Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.): The IME report is missing, without saying the patient missed the exam.
  • N582 (Benefits suspended pending the patient's cooperation.): Benefits suspended until the patient cooperates.
  • N591 (Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).): Payment was based on an IME or utilization review.

N593 FAQ

Can the IME be rescheduled?

Often, especially if the patient had a valid reason. The patient or their attorney should contact the insurer promptly.

Does N593 affect services before the missed exam?

It depends on the policy and state law. Some rules cut off benefits only from the missed exam forward, while others may affect the whole claim. Ask the adjuster which dates are affected.

Can the provider attend the IME for the patient?

No. The IME is an examination of the patient by an independent examiner. The provider can only supply records if requested.