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N860 Remark Code: Cost Share Based on QPA

N860 is an alert that the member's cost sharing was calculated using the Qualifying Payment Amount (QPA) under the Federal No Surprises Act. The QPA is generally the plan's median in-network rate for the service in that area, and it sets the base for the patient's deductible, copay, or coinsurance.

Quick facts

Code
N860 (RARC N860)
Status
Active In use since November 1, 2021.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): The patient's share was calculated from the QPA and is the most the patient can be billed for the service.
Official description
Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N860 means

Under the No Surprises Act, patients receiving protected out-of-network care pay cost sharing as if the care were in network. The amount that cost sharing is calculated from is called the recognized amount, and in many cases that’s the Qualifying Payment Amount. N860 tells you the plan used the QPA for this claim.

In practice, the patient’s deductible and coinsurance on the remittance are based on the QPA, not your billed charge, and those amounts count toward the patient’s in-network cost-sharing totals.

What to do

  1. Bill the patient only the PR amounts reported. They already reflect the QPA calculation.
  2. Review the QPA disclosure the plan provides with its payment if the numbers seem off.
  3. Treat the payment separately. If you think the plan’s payment is too low, use federal open negotiation and IDR; the QPA figure for cost sharing isn’t what you’d dispute.
  4. Refund patients who paid more up front than the PR amount.

Codes that may appear with N860

  • PR-1 (Deductible Amount): Deductible amount calculated from the QPA.
  • PR-2 (Coinsurance Amount): Coinsurance calculated from the QPA.
  • N862 (Alert: Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge.): Cost share was based on the lesser of the QPA or the billed charge.
  • N869 (Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.): Another alert stating cost sharing was calculated from the QPA.
  • N859 (Alert: The Federal No Surprise Billing Act was applied to the processing of this claim.): The general alert that the No Surprises Act was applied.

N860 FAQ

What is the Qualifying Payment Amount?

It's generally the plan's median contracted rate for the same or similar service in the same geographic area, calculated under federal rules. Plans must disclose certain QPA information to providers.

Is the QPA also what the plan pays me?

Not necessarily. The QPA drives the patient's cost sharing. The plan's payment is its initial payment, which you can challenge through open negotiation and federal IDR.

Can I ask how the QPA was calculated?

Plans must provide certain QPA information with the initial payment or denial and more on request. Ask the plan if you need it for a dispute.