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N78 Remark Code: EPSDT Checkup Components Incomplete

N78 means the necessary components of the child and teen checkup, known as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) visit, were not completed or not reported. The payer will not pay the visit as a full EPSDT screening.

Quick facts

Code
N78 (RARC N78)
Status
Active In use since January 1, 2000.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The screening payment is denied or reduced for the provider. Medicaid rules generally prohibit billing the family.
  • PI (Payer Initiated Reduction): A payer-initiated adjustment by the Medicaid program or plan for an incomplete screening.
Official description
The necessary components of the child and teen checkup (EPSDT) were not completed.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N78 means

EPSDT is the Medicaid benefit for children and adolescents under 21. A periodic EPSDT screening is more than a routine visit: it must include a defined set of components. Many state programs call it by a local name, such as a child and teen checkup. When the claim or the record does not show all required components, the program may deny or reduce payment and send N78.

N78 usually appears with CARC 272 or CARC 16.

Common causes

  • An age-appropriate component, such as vision, hearing, developmental, or lead screening, was not performed or not documented.
  • Immunizations due at the visit were not given and no deferral reason was recorded.
  • The claim lacked state-required indicators, modifiers, or referral codes that show components were completed.
  • Separate claims for components, such as labs, did not link to the screening visit.

What to do

  1. Review the state’s EPSDT periodicity schedule for the child’s age at the time of the visit.
  2. Compare it with the documentation to find which component is missing.
  3. Add missing claim indicators if the component was done but not reported, and submit a corrected claim.
  4. Schedule a follow-up to complete any missed component, then bill according to state rules.
  5. Appeal if the record shows the visit was complete.

How to prevent it

Use EPSDT visit templates that list every required component by age, and require staff to mark each one as done, deferred with reason, or referred. Configure claims so state-required EPSDT indicators populate automatically.

Codes that may appear with N78

  • CO-272 (Coverage/program guidelines were not met.): Coverage or program guidelines, here the EPSDT components, were not met.
  • CO-16 (Claim/service lacks information or has submission/billing error(s).): Required information, such as component indicators or referral codes, was missing from the claim.
  • N33 (No record of health check prior to initiation of treatment.): No record of a health check before treatment began.
  • N146 (Missing screening document.): A required screening document is missing.
  • N243 (Incomplete/invalid/not approved screening document.): The screening document is incomplete, invalid, or not approved.

N78 FAQ

What are the required EPSDT components?

Federal rules call for a comprehensive health and developmental history, an unclothed physical exam, appropriate immunizations, lab tests including lead screening where required, and health education. States define how each is documented and billed.

What if a component was deferred?

Some states allow deferral with documentation, for example when immunizations were given elsewhere. Report it the way your state requires.

Can I bill a regular sick visit instead?

Only if that is what was provided and documented. Billing a problem-oriented visit to replace an incomplete screening can create other compliance problems.