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N638 Remark Code: Priced on Home Health Fee Schedule

N638 means the payer calculated payment using its home health fee schedule. It explains how the allowed amount was reached; the difference between your charge and that amount usually appears as a contractual adjustment.

Quick facts

Code
N638 (RARC N638)
Status
Active In use since July 15, 2013.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The reduction from billed charges to the home health fee schedule amount is a contractual or legislated write-off, not patient responsibility.
  • PR (Patient Responsibility): Any deductible, coinsurance, or copay applied after pricing is reported separately under PR and may be billed to the patient.
Official description
Reimbursement has been made according to the home health fee schedule.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N638 means

Payers maintain different pricing methods for different care settings. N638 identifies the one used on this claim: the payer’s home health fee schedule. It usually accompanies CARC 45, which carries the dollar reduction, while N638 tells you which schedule set the allowed amount.

The schedule could be a commercial payer’s contracted home health rates, a Medicaid program’s home health schedule, or a workers’ compensation or other state-mandated schedule. The remark does not say which kind; the payer and the claim type tell you that.

When N638 is worth a closer look

For a home health agency billing its normal services, N638 is expected. It deserves attention when:

  • The allowed amount is below your contracted rate for the service, visit type, and date of service.
  • The claim was not home health care. A clinic or outpatient service priced this way may reflect a wrong place of service, a provider enrollment record that lists the wrong setting, or a payer configuration error.
  • The schedule year looks wrong, for example an older rate applied to a newer date of service.

What to do

  1. Compare the allowed amount to the home health rate you expected for that service and date.
  2. If it matches, post the difference as a contractual adjustment and bill the patient only for PR amounts.
  3. If the setting is wrong, check the place of service (box 24B on a professional claim) and your enrollment details, then submit a corrected claim with resubmission code 7 if the claim itself was wrong.
  4. If the rate is wrong, contact provider services with your contract or the published schedule and request reprocessing, or use the payer’s reconsideration process.

Tracking allowed amounts by remark code helps you spot a schedule loaded at the wrong rate, which affects every claim rather than just one. An ERA Analyzer review can surface that kind of pattern across payments.

Codes that may appear with N638

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The most common companion: the charge exceeded the fee schedule amount, and N638 names which schedule was used.
  • PR-1 / PR-2 (Deductible and coinsurance.): Patient cost-sharing applied to the home health allowed amount.
  • N639 (Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.): The same kind of pricing explanation, but for the inpatient rehabilitation facility fee schedule.
  • N673 (Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.): Pricing based on an outpatient per diem, factor, or fee schedule amount.
  • N442 (Payment based on an alternate fee schedule.): Payment based on an alternate fee schedule, without naming a specific setting.
  • N669 (Adjusted based on the Medicare fee schedule.): Pricing based on the Medicare fee schedule.

N638 FAQ

Is N638 a denial?

No. It is a pricing explanation attached to a processed claim. Action is only needed if the allowed amount is not what you expected.

Why would a claim be priced on the home health schedule when it was not a home health agency claim?

The payer may have identified the service or place of service as home-based care. If that is wrong, check the place of service, bill type, and provider setup, then contact the payer.

Where do I find the home health fee schedule the payer used?

It depends on the payer. Contracted payers usually publish it or include it in the agreement; state programs and workers' compensation systems publish their own schedules.