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N864 Remark Code: NSA Emergency Services Rules Apply

N864 is an alert that the claim is subject to the No Surprises Act provisions that apply to emergency services. Out-of-network emergency care must be covered with in-network cost sharing, and the provider may not balance bill the patient for protected services.

Quick facts

Code
N864 (RARC N864)
Status
Active In use since March 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Cost sharing is calculated as if the emergency care were in network. That's the most the patient owes.
  • CO (Contractual Obligation): Amounts above the plan's payment and the patient's cost share can't be billed to the patient.
Official description
Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N864 means

The No Surprises Act has separate provisions for different situations. N864 identifies the emergency provision. When an insured patient receives emergency services from an out-of-network provider or facility, the plan must cover them without prior authorization and with in-network cost sharing, and the provider can’t balance bill.

The alert tells you which set of rules the plan applied, which helps when you’re checking cost sharing or planning a dispute.

What to do

  1. Collect only the PR amount and refund anything above it.
  2. Check post-stabilization services. Care after the patient is stable may also be protected unless notice and consent conditions were met.
  3. Review the payment and start open negotiation within the deadline if you disagree with it.
  4. Keep the claim tagged as NSA emergency so it stays out of ordinary balance billing workflows.

Codes that may appear with N864

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge was reduced to the plan's payment for the emergency service.
  • PR-2 (Coinsurance Amount): Coinsurance at in-network levels.
  • N865 (Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a…): The Act's provisions for nonemergency services at in-network facilities.
  • N866 (Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance…): The Act's provisions for air ambulance services.
  • CO-40 (Charges do not meet qualifications for emergent/urgent care.): Charges that don't meet qualifications for emergent or urgent care, a different kind of emergency-related adjustment.

N864 FAQ

Which emergency services are protected?

Generally emergency services in a hospital emergency department or independent freestanding emergency department, and in some cases post-stabilization services unless notice and consent requirements are met.

Can the plan require prior authorization for emergency care?

The Act generally bars plans from requiring prior authorization for protected emergency services or denying them based on network status.

Can I dispute the payment?

Yes, through federal open negotiation and IDR, unless a state law or All-Payer Model Agreement sets the rate.