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N722 Remark Code: Workers' Comp Set-Aside Must Pay

N722 means the patient has a Workers' Compensation Set-Aside (WCSA) from a settled work injury claim, and this service must be paid from those set-aside funds rather than by this payer. It is most often seen on Medicare claims.

Quick facts

Code
N722 (RARC N722)
Status
Active In use since March 1, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The payer assigns the amount to the patient, whose set-aside funds are meant to cover it. The patient or the fund administrator pays, not this payer.
Official description
Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N722 means

When a workers’ compensation claim settles and the injured person is, or is expected to become, a Medicare beneficiary, the settlement may include a Workers’ Compensation Set-Aside: money reserved for future medical care related to the work injury. Until those funds are properly used up, Medicare generally expects them to pay first for injury-related care.

N722 tells you the payer matched this service to such an arrangement. It typically appears with CARC 201 under group PR, meaning the patient, through the set-aside, is responsible.

Common causes

  • The diagnosis on the claim matches the injury covered by the settlement.
  • The patient did not mention the settlement at registration, so the claim went to the health plan by default.
  • The set-aside administrator was never identified as a payment source.

What to do

  1. Talk to the patient. Confirm the settlement and who administers the set-aside funds.
  2. Verify the link to the injury. If the service treats an unrelated condition, review your diagnosis coding. An incorrect injury-related diagnosis can trigger N722.
  3. Bill the set-aside. Send the bill to the patient or administrator as they direct. Payment practices for these accounts vary by administrator.
  4. If the funds are exhausted, ask the administrator for documentation and follow the payer’s process for resubmitting once the set-aside no longer applies.
  5. If the determination is wrong, contact the payer to correct its records before resubmitting.

How to prevent it

Ask about work injury settlements during intake for patients treated for workplace injuries. Record the set-aside and its administrator on the account so injury-related claims are routed correctly from the start. Background on sorting out payer order is in eligibility and COB denials.

Codes that may appear with N722

  • PR-201 (Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. (Use only with Group Code PR)): The patient is responsible through a set-aside arrangement; N722 specifies a workers' compensation one.
  • PR-P3 (Workers' Compensation case settled.): The workers' compensation case settled and the patient is responsible through a Medicare set-aside.
  • N723 (Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.): The same concept for a liability settlement set-aside.
  • N724 (Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.): The same concept for a no-fault settlement set-aside.
  • N728 (A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.): A workers' compensation carrier still has open, ongoing responsibility, which is different from a settled case with a set-aside.

N722 FAQ

What is a workers' compensation set-aside?

When a work injury claim settles, part of the settlement may be set aside to pay future medical costs related to the injury that Medicare would otherwise cover. Those funds must be used first for that care.

Who do I bill when I get N722?

Bill the patient or whoever administers the set-aside account, which may be the patient, a professional administrator, or a custodial arrangement. Ask the patient who manages the funds.

Does N722 apply to unrelated care?

It should apply only to services related to the settled injury. If the service is unrelated, check the diagnosis codes on the claim and contact the payer to correct the determination.