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N757 Remark Code: Federal Indian Fee Schedule (MLR)

N757 means payment was adjusted based on the Federal Indian fee schedule, known as Medicare-like rates (MLR). It generally applies when care is purchased or referred by an Indian Health Service, tribal, or urban Indian program.

Quick facts

Code
N757 (RARC N757)
Status
Active In use since July 1, 2015.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The difference between your charge and the MLR amount is a required reduction. Under these rules, the patient generally cannot be balance billed for it.
Official description
Adjusted based on the Federal Indian Fees schedule (MLR).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N757 means

The Indian Health Service, tribal health programs, and urban Indian organizations often purchase or refer care from outside providers when a service is not available directly. Federal regulations set the payment for much of that care at Medicare-like rates, abbreviated MLR. N757 tells you your claim was priced on that basis.

It is a pricing remark, usually paired with CARC 45 or CARC 223. It does not mean the claim was denied.

When to look closer

  • The allowed amount seems lower than what Medicare methodology would produce for the same service.
  • The service was not actually purchased or referred by an Indian health program.
  • You have a separate negotiated agreement with the program that should apply instead.

What to do

  1. Confirm the service was authorized as purchased or referred care and that the referral covered it.
  2. Check that the allowed amount matches the MLR method for the service and date.
  3. Post the adjustment as a required reduction, not a patient balance.
  4. If the pricing is wrong or another agreement applies, contact the program or its fiscal intermediary with your documentation.
  5. For services without an authorization, ask the program about its process before billing anyone else.

How to prevent problems

Verify purchased or referred care authorizations before the service and file them with the account. Setting up a distinct payer and fee schedule profile for MLR claims makes it easier to confirm payments are correct and to separate them from standard contractual adjustments.

Codes that may appear with N757

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge exceeds the allowed amount, which was set using Medicare-like rates.
  • 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…): An adjustment required by federal law or regulation.
  • N533 (Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.): Services performed in an Indian Health Services facility under a self-insured tribal group health plan.
  • N801 (Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation…): Services in a Medicare-participating or critical access facility under a self-insured tribal group health plan.
  • N600 (Adjusted based on the applicable fee schedule for the region in which the service was rendered.): Adjusted based on the regional fee schedule, a different fee schedule basis.

N757 FAQ

What are Medicare-like rates?

They are payment amounts, based on Medicare methodology, that federal regulations set for certain care purchased or referred by Indian health programs. They cap what the program pays for covered services.

Which providers are affected by N757?

The rules apply to Medicare-participating hospitals for certain referred care, and in many cases to other providers furnishing purchased or referred care. Exact applicability depends on the service and the program.

Can I bill the patient for the difference?

Generally no. Payment under these rules is typically considered payment in full for authorized services. Check the referral terms and applicable regulations.