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N65 Remark Code: Procedure or Rate Not on File

N65 means the procedure code or procedure rate count cannot be determined, or was not on file, for the date of service or provider. The payer's system could not find a valid code or a rate to price the service for that provider on that date.

Quick facts

Code
N65 (RARC N65)
Status
Active In use since January 1, 2000; last modified February 28, 2003.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The claim is denied pending correction of the code or the payer's fee schedule. It is not billable to the patient.
  • OA (Other Adjustment): Some payers report it as another adjustment because the service could not be priced.
Official description
Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N65 means

To pay a claim line, a payer needs two things: a valid procedure code and a way to price it for your provider on that date. N65 says one of those failed. Either the code is not recognized for the date of service, or the payer has no rate for the code under your provider’s contract or fee schedule.

N65 often accompanies CARC 16 or CARC 181. When the underlying issue is a missing contract rate, CARC 147 may appear.

Common causes

  • The procedure code was deleted or not yet effective on the date of service.
  • The payer had not loaded a new code into its fee schedule.
  • Your contract or provider type does not include a rate for that code.
  • A contract expired or renewed without the fee schedule being loaded.
  • The code was mistyped into a combination that does not exist.

How to fix it

  1. Validate the code for the date of service using current code sets.
  2. Correct and resubmit with resubmission code 7 if the code was wrong.
  3. Contact the payer if the code was valid. Ask whether it is loaded on your fee schedule and provider record.
  4. Request a fee schedule correction if your contract includes the service, and ask for reprocessing once the rate is loaded.
  5. Check your contract to confirm whether the service is covered and how it should be priced.

How to prevent it

Before offering a new service, confirm with each payer that the code is covered under your contract and priced. Review fee schedules after each contract renewal and annual code update, and monitor for N65 spikes that could point to a payer setup error.

Codes that may appear with N65

  • CO-16 (Claim/service lacks information or has submission/billing error(s).): A billing error, such as an invalid procedure code.
  • CO-181 (Procedure code was invalid on the date of service.): The procedure code was invalid on the date of service.
  • CO-147 (Provider contracted/negotiated rate expired or not on file.): The provider's contracted or negotiated rate expired or is not on file.
  • N56 (Procedure code billed is not correct/valid for the services billed or the date of service billed.): The procedure code is not correct or valid for the service or date billed.
  • N144 (The rate changed during the dates of service billed.): The rate changed during the dates of service billed.
  • CO-189 ('Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service): An unlisted code was billed when a specific code exists.

N65 FAQ

How can I tell whether the problem is my code or the payer's fee schedule?

If the code is valid for the date of service and correctly reported, the payer's fee schedule for your contract or provider type may be missing it. Ask provider services whether the code is loaded for your contract.

What does 'procedure rate count' mean?

It generally refers to the payer's count or pricing information for the procedure, such as the units or rate structure it uses. If it cannot be determined, the service cannot be priced.

Should I appeal?

If the payer's fee schedule is missing a code that your contract covers, ask for a fee schedule correction and reprocessing. An appeal may be needed if the payer will not update it.