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N630 Remark Code: Referral Not Authorized by Attending

N630 means the payer denied the service because the referral was not authorized by the attending physician. In workers' compensation and some auto systems, the treating (attending) physician must direct referrals to other providers.

Quick facts

Code
N630 (RARC N630)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The provider who saw the patient without a proper referral is responsible. Injury programs usually bar billing the patient.
Official description
Referral not authorized by attending physician.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N630 means

Many injury systems give one physician, the attending or treating physician, control over the patient’s care, including who else the patient sees. N630 says the service you billed came from a referral the attending physician didn’t authorize. The patient may have been sent by someone else, or may have come on their own.

It mirrors CARC P17 and can appear with CARC 288 or 243.

Common causes

  • The patient self-referred to a specialist or therapist.
  • A different provider, such as an urgent care clinic, made the referral instead of the attending physician.
  • The referral was made after the attending physician changed and the new physician didn’t renew it.
  • The referral existed but wasn’t sent with the bill.

How to fix it

  1. Ask the patient who referred them and get a copy of any referral.
  2. Confirm the attending physician of record with the adjuster.
  3. If a valid referral exists, resubmit or appeal with it attached.
  4. If not, ask the attending physician whether they will issue a referral and whether the carrier accepts it retroactively.
  5. Write off services the carrier won’t cover, following state rules on billing injured patients.

How to prevent it

Before scheduling an injury patient, get the attending physician’s written referral and the adjuster’s confirmation. For referral workflows in general, see authorization and referral denials.

Codes that may appear with N630

  • CO-P17 (Referral not authorized by attending physician per regulatory requirement.): Referral not authorized by the attending physician per regulatory requirement.
  • CO-288 (Referral absent): Referral absent.
  • CO-243 (Services not authorized by network/primary care providers.): Services not authorized by network or primary care providers.
  • N489 (Missing referral form.): The referral form is missing.
  • N612 (Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.): Provider not authorized to treat injured workers in this jurisdiction.
  • N285 (Missing/incomplete/invalid referring provider name.): The referring provider's name is missing or invalid.

N630 FAQ

Who is the attending physician?

The provider responsible for the injured person's overall care on the claim, sometimes called the treating or primary treating physician. State rules define the role.

Can the adjuster authorize the referral instead?

Sometimes carriers approve referrals directly, but where the rules require the attending physician's referral, that is what the payer looks for.

Can a referral be obtained after the visit?

Some payers accept a retroactive referral, others don't. Ask the carrier before relying on one.