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N807 Remark Code: MIPS Payment Adjustment

N807 means the payment on this line was adjusted under the Merit-based Incentive Payment System (MIPS), Medicare's quality payment program. The adjustment, up or down, reflects the clinician's MIPS final score from an earlier performance year, not anything wrong with this claim.

Quick facts

Code
N807 (RARC N807)
Status
Active In use since July 1, 2018.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): A negative MIPS adjustment is a provider liability and may not be passed on to the patient.
Official description
Payment adjustment based on the Merit-based Incentive Payment System (MIPS).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N807 means

MIPS is one of Medicare’s value-based payment tracks under the Quality Payment Program. Eligible clinicians receive a final score based on quality, cost, and other performance categories, and that score translates into a percentage adjustment applied to their Medicare Part B payments in a later payment year.

N807 is how the remittance shows that adjustment. Negative adjustments generally appear with CARC 237 (legislated or regulatory penalty); positive ones with CARC 144 (incentive adjustment). The claim itself was processed normally; the MIPS percentage was applied on top of the allowed amount.

Why it happens

  • A score below the performance threshold leads to a negative adjustment.
  • A score above the threshold leads to a positive adjustment, often small.
  • No data submitted for a clinician who was required to participate generally results in the maximum negative adjustment for that year.
  • Scores are tied to the TIN/NPI combination, so a clinician billing under a different group can carry a different adjustment.

What to do

  1. Confirm the clinician and TIN on the claim match the combination you expect.
  2. Look up the MIPS final score and payment adjustment for the relevant performance year in the CMS Quality Payment Program portal.
  3. Check the percentage. If the applied adjustment doesn’t match the published one, contact the Medicare Administrative Contractor.
  4. If you believe the score is wrong, consider CMS’s targeted review process within its request window.
  5. Post the adjustment separately from contractual adjustments so it doesn’t look like a fee-schedule problem.

How to plan ahead

  • Track MIPS reporting deadlines and submission status for each clinician and TIN.
  • Model the expected adjustment each year so finance can budget for it.
  • Use ERA Analyzer to total N807 adjustments by clinician and see the real cost of a score.

Codes that may appear with N807

  • CO-237 (Legislated/Regulatory Penalty.): A legislated or regulatory penalty, used for a negative adjustment.
  • CO-144 (Incentive adjustment, e.g. preferred product/service.): An incentive adjustment, used when MIPS increases payment.
  • N699 (Payment adjusted based on the Physician Quality Reporting System (PQRS)): An adjustment under the older Physician Quality Reporting System (PQRS) program.
  • N701 (Payment adjusted based on the Value-based Payment Modifier.): An adjustment under the Value-based Payment Modifier, which MIPS replaced.
  • N551 (Payment adjusted based on the Ambulatory Surgical Center (ASC)): A quality-program adjustment for ambulatory surgical centers.

N807 FAQ

Does N807 mean I coded the claim incorrectly?

No. The adjustment is applied to eligible Medicare Part B payments because of the clinician's MIPS result. Correcting the claim won't remove it.

Why does this year's payment reflect an older year?

MIPS applies payment adjustments in a payment year based on performance from an earlier performance year, generally two years before. Look up the score for the matching performance year.

Can I dispute a MIPS adjustment?

CMS offers a targeted review process for clinicians who believe their MIPS score was calculated incorrectly, with a limited request window. The claim-level adjustment itself isn't appealed through normal claim appeals.