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N862 Remark Code: Cost Share From Lesser of QPA or Charge

N862 is an alert that the member's cost share complies with the No Surprises Act and was calculated using the lesser of the Qualifying Payment Amount (QPA) or the billed charge. The patient's share can't be based on more than your charge, and it can't be based on more than the QPA.

Quick facts

Code
N862 (RARC N862)
Status
Active In use since March 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): This is the patient's full cost share for the service under the Act.
Official description
Alert: Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N862 means

When no All-Payer Model Agreement or specified state law applies, the No Surprises Act bases patient cost sharing for protected services on the lesser of two numbers: the plan’s Qualifying Payment Amount or the provider’s billed charge. N862 confirms the plan followed that rule on this claim.

The practical effect is a ceiling. The coinsurance or deductible shown as PR is calculated from whichever figure is lower, and the patient owes only that.

What to do

  1. Bill the patient only the PR amount. It is already capped under the Act.
  2. Refund any excess collected at the time of service.
  3. Review the payment separately. If you believe the plan’s payment is too low, use federal open negotiation and IDR within their deadlines.
  4. Keep your charges consistent. The lesser-of rule means unusually low charges reduce cost sharing, while patient liability remains capped by the QPA.

Codes that may appear with N862

  • PR-2 (Coinsurance Amount): Coinsurance calculated from the lesser of the QPA or billed charge.
  • PR-1 (Deductible Amount): Deductible amount calculated the same way.
  • N860 (Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).): Cost sharing was calculated from the QPA.
  • N870 (Alert: In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying…): Cost sharing was based on the billed amount because it was lower than the QPA.
  • N867 (Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.): Cost sharing was based on a specified state law instead.

N862 FAQ

Why would my billed charge be lower than the QPA?

It happens when your charge for the service is below the plan's median in-network rate for that area. In that case cost sharing is based on your charge.

Does N862 mean I was underpaid?

Not by itself. It describes the patient's cost share. Review the plan's payment separately and use open negotiation if you disagree with it.

Should I change anything on future claims?

No. Bill your normal charge and let the plan apply the Act's cost-sharing rules.