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N605 Remark Code: New York No-Fault APR-DRG Fee

N605 means the New York no-fault insurer calculated the fee using the New York All Patients Refined Diagnosis Related Groups (APR-DRG) system, as provided by Regulation 68. It applies to hospital inpatient claims under New York auto no-fault coverage.

Quick facts

Code
N605 (RARC N605)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The difference between billed charges and the APR-DRG-based payment is a hospital write-off under New York no-fault rules.
Official description
This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N605 means

When a New York hospital bills a no-fault auto insurer for an inpatient stay, payment is based on the state’s APR-DRG methodology rather than on billed charges. N605 tells you the carrier used that method, as Regulation 68 provides, to calculate the fee.

This is a New York, institutional, property and casualty remark code. It generally appears with CARC P23 or CARC 45.

What drives the payment

  • The assigned APR-DRG, based on principal and secondary diagnoses, procedures, age, and discharge status.
  • Severity of illness and risk of mortality subclasses within the group.
  • Hospital-specific rates and any outlier provisions that apply.

How to review it

  1. Regroup the claim with your own grouper and compare the result with the carrier’s DRG.
  2. Check the coding. Missing secondary diagnoses or an incorrect discharge status can lower the group.
  3. Confirm the hospital rate the carrier used for the discharge date.
  4. Submit a corrected claim if coding was incomplete, or request repricing if the carrier’s inputs were wrong.
  5. Escalate through the carrier and New York’s no-fault dispute options if needed.

Staying accurate

Run the same coding quality checks on no-fault inpatient claims that you use for other DRG payers, and keep New York no-fault submission deadlines in your workflow.

Codes that may appear with N605

  • CO-P23 (Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)): A no-fault jurisdictional fee schedule adjustment.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge exceeds the fee schedule or maximum allowable amount.
  • N604 (In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule…): New York no-fault professional fees based on the workers' compensation schedule.
  • N647 (Adjusted based on diagnosis-related group (DRG).): A general adjustment based on a diagnosis-related group.
  • N208 (Missing/incomplete/invalid DRG code.): The DRG code on the claim is missing, incomplete, or invalid.

N605 FAQ

What is APR-DRG?

A grouping system that assigns each inpatient stay to a diagnosis-related group adjusted for severity of illness and risk of mortality. New York uses it for many inpatient payment programs.

Does N605 apply to professional claims?

No. It concerns hospital inpatient payment. Physicians billing no-fault typically see N604 instead.

Why might the DRG differ from what we expected?

The group depends on diagnosis and procedure coding, discharge status, and other data on the claim. A missed secondary diagnosis or wrong discharge status can change the group.