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N733 Remark Code: Surcharges Paid to the State

N733 means the regulatory surcharge associated with this claim was paid directly to the state rather than included in the payment to the provider. It explains an adjustment for a state-mandated surcharge or assessment and generally needs no correction.

Quick facts

Code
N733 (RARC N733)
Status
Active In use since November 1, 2014.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The surcharge amount is removed from the provider payment because the payer remitted it to the state. It is not billable to the patient.
  • OA (Other Adjustment): Some payers report the surcharge with OA as an administrative adjustment. It is not patient responsibility.
Official description
Regulatory surcharges are paid directly to the state.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N733 means

Certain states fund health programs through surcharges or assessments on payments for some health care services. Depending on the state’s rules, the payer may send the surcharge straight to the state instead of passing it through the provider.

N733 is the payer telling you that happened on this claim. It usually accompanies CARC 137, which covers regulatory surcharges, assessments, and health-related taxes. The claim was processed; this line simply accounts for money that went to the state.

When to look closer

  • The surcharge appears on services or payers where you do not normally see it.
  • The amount looks different from similar claims processed at the same time.
  • Your facility expected to receive and remit the surcharge itself, but the payer paid it directly.

What to do

  1. Post the amount as a regulatory surcharge adjustment according to your internal policy.
  2. Do not bill the patient for it.
  3. If the surcharge seems wrong for the service or payer, ask the payer to explain how it was calculated and which state rule applies.
  4. Coordinate with your finance team so surcharge reporting to the state is not duplicated when the payer has already paid it.

How to prevent confusion

Set up a distinct adjustment code in your practice management system for surcharges paid directly to the state. Keeping them separate from denials and contractual adjustments makes reconciliation and reporting much easier, and a periodic ERA review can confirm they are being posted consistently.

Codes that may appear with N733

  • CO-137 (Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.): Regulatory surcharges, assessments, allowances, or health-related taxes; N733 says where the money went.
  • CO-223 (Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code…): A general adjustment for a mandated law or regulation, occasionally used for the same purpose.
  • N44Deactivated (Payer's share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.): An older, now deactivated remark saying the payer's share of surcharges was paid directly to the regulatory authority.
  • CO-212 (Administrative surcharges are not covered): Administrative surcharges are not covered, a different situation from a surcharge paid on the claim's behalf.

N733 FAQ

Why is a surcharge on my remittance at all?

Some states impose surcharges or assessments on certain health care payments, and the law may require the payer to send that amount to the state. The remittance shows it so the claim balances.

Should I write off the N733 amount?

Post it according to your organization's policy for state surcharges. It is not a denial, and it should not be billed to the patient.

Does N733 apply in every state?

No. It appears only where a state has a surcharge that is paid directly to the state. Your state's rules determine when it applies.