N654 Remark Code: Maximum Medical Improvement Reached
N654 means the payer adjusted the service because the injured person has been found to have reached maximum medical improvement (MMI), the point where further recovery is not expected. After MMI, many carriers limit or stop paying for ongoing treatment.
Quick facts
- Code
- N654 (RARC N654)
- Status
- Active In use since July 15, 2013.
- Code set
- Remittance Advice Remark Codes (RARC)
- Group codes
-
- CO (Contractual Obligation): The carrier is not paying the service after MMI. In many jurisdictions the provider cannot bill the injured worker for treatment related to the compensable injury.
- PR (Patient Responsibility): Rarely, a carrier indicates the patient is responsible. State workers' compensation rules decide whether that is allowed.
- Official description
Adjusted based on achievement of maximum medical improvement (MMI).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026- Last verified
- against the official X12 list.
What N654 means
In workers’ compensation, maximum medical improvement is the point at which an injured worker’s condition has stabilized and is not expected to improve meaningfully with more treatment. It is a legal and clinical milestone. It often triggers an impairment rating and a change in the type of benefits the worker receives.
When a carrier receives a bill for services after the MMI date and its rules do not cover that care, it reduces or denies the line and adds N654. The remark does not say the service was clinically wrong. It says the claim’s status changed.
Common situations
- Treatment continued on the same plan after a physician or independent examiner declared MMI.
- The provider was not told about an MMI finding made by another examiner.
- Post-MMI maintenance care was provided without the approval the jurisdiction requires.
- The carrier applied an MMI date that is earlier than the one the treating provider documented.
What to do
- Get the MMI date and source from the adjuster, including who made the finding.
- Compare the service dates. Services before the MMI date should not be affected; request reprocessing if they were.
- Check whether post-MMI care is allowed in the jurisdiction, and whether approval was needed and obtained.
- Dispute the MMI finding through the state’s process if the treating provider disagrees and the clinical record supports further improvement.
- Avoid billing the worker unless state law permits it.
How to prevent it
Ask the adjuster regularly about claim status on long-running cases, especially after an independent medical exam. Once MMI is declared, get written approval before continuing any treatment.
Codes that may appear with N654
Related and easily confused codes
- N641 (Reimbursement has been based on the number of body areas rated.): Payment for an impairment rating, which is often done at MMI.
- N591 (Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).): Payment based on an independent medical exam or utilization review, which may be where the MMI finding came from.
- N585 (Benefits are no longer available based on a final injury settlement.): Benefits have ended because of a final injury settlement.
N654 FAQ
Does MMI mean all treatment stops?
Not always. Many jurisdictions allow some maintenance or future medical care after MMI, sometimes with approval. What is payable depends on the state and the claim.
Who decides the worker is at MMI?
Usually the treating physician or an independent medical examiner, under the jurisdiction's rules. If the treating provider disagrees with an examiner's finding, the dispute process varies by state.
Can I appeal an N654 adjustment?
You can request reconsideration if the care was authorized, was provided before the MMI date, or falls within allowed post-MMI care. Follow the carrier's and the state's dispute procedures.