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N609 Remark Code: 80% of Billed Amount Under Act 6

N609 means the carrier is recommending payment of 80% of the provider's billed amount according to Act 6. It typically applies when there is no Medicare fee schedule amount to base the payment on.

Quick facts

Code
N609 (RARC N609)
Status
Active In use since July 15, 2013; last modified March 14, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The 20% reduction from billed charges under Act 6. The provider generally cannot collect it from the patient.
Official description
80% of the provider's billed amount is being recommended for payment according to Act 6.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N609 means

Pennsylvania’s Act 6 generally ties auto injury payments to Medicare. For services that Medicare doesn’t price, the law provides a fallback based on the provider’s charge. N609 tells you the carrier applied a charge-based calculation, recommending payment of 80% of what you billed.

This remark is used on Pennsylvania auto injury claims. It commonly appears with CARC P22 or P23.

When you’ll see it

  • The service has no Medicare fee schedule amount, such as certain supplies or services Medicare doesn’t cover.
  • The carrier couldn’t match the code to a Medicare amount, which may point to a coding issue.

What to check

  1. Confirm there is truly no Medicare amount for the code and date of service. If there is one, the 110% rule described under N608 should apply instead.
  2. Verify the code and modifiers. An invalid or outdated code can push a claim into the fallback method.
  3. Recalculate 80% of your billed charge and compare it with the allowance.
  4. Correct or dispute as needed, using a corrected bill for coding errors or a written reconsideration for calculation errors.

Good practice

Keep one charge master for all payers, and review auto injury claims that fall into N609 for coding problems. Claims Validator can check codes before submission so valid, priceable codes go out the first time.

Codes that may appear with N609

  • CO-P22 (Payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP)): Adjusted under PIP or medical payments jurisdictional rules.
  • CO-P23 (Medical Payments Coverage (MPC) or Personal Injury Protection (PIP)): A PIP or medical payments jurisdictional fee schedule adjustment.
  • N608 (The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service.): Act 6 allowance at 110% of the Medicare Fee Schedule.
  • N631 (Medical Fee Schedule does not list this code.): The fee schedule does not list the code, so a comparable service was used.
  • CO-P5 (Based on payer reasonable and customary fees.): Based on the payer's reasonable and customary fees where no legislated maximum exists.

N609 FAQ

When does Act 6 use 80% of the billed amount?

Generally when Medicare has no payment amount for the service. Confirm the reason with the carrier if you expected a Medicare-based amount.

Should I raise my charges to increase the payment?

Charges should reflect your standard fee for all payers. Setting them differently for auto claims can raise compliance and contract issues.

Is 'recommended' the same as paid?

It is the amount the carrier considers payable. Check the paid amount and any policy-level deductions on the remittance.