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N865 Remark Code: NSA Out-of-Network Care, In-Network Site

N865 is an alert that the claim falls under the No Surprises Act provisions for nonemergency services furnished by nonparticipating providers during a visit to a participating facility. The patient pays in-network cost sharing, and balance billing is barred unless a valid notice and consent exception applies.

Quick facts

Code
N865 (RARC N865)
Status
Active In use since March 1, 2022.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • PR (Patient Responsibility): Patient cost sharing is based on in-network levels under the Act.
  • CO (Contractual Obligation): The difference between your charge and the plan's payment can't be billed to the patient when the protections apply.
Official description
Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating facility.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N865 means

A patient can pick an in-network hospital or surgery center and still be treated by clinicians who aren’t in their network. The No Surprises Act addresses that situation. N865 is the alert that those provisions applied to your claim: the patient pays in-network cost sharing, and you can’t balance bill unless a valid exception applies.

The main exception is notice and consent, which lets some out-of-network providers bill more if the patient agreed in advance on a federally specified form. Many specialties can’t use it at all.

What to do

  1. Bill only the PR amount unless you have a valid, compliant notice and consent for a service where it’s allowed.
  2. Review consent documentation before relying on it; if it’s missing or noncompliant, the protections apply.
  3. Evaluate the payment and send an open negotiation notice within the deadline if you disagree.
  4. Talk with facility partners about network status for your specialty so patients get accurate estimates.

Codes that may appear with N865

  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The charge was reduced to the plan's payment.
  • PR-2 (Coinsurance Amount): Coinsurance at in-network levels.
  • N864 (Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.): The Act's provisions for emergency services.
  • N879 (Alert: The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the…): An alert about notice and consent to balance bill that was obtained from the patient.
  • N878 (Alert: The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and…): The provider said notice and consent were given, but they didn't meet requirements.

N865 FAQ

Which situations does N865 cover?

Typically an out-of-network clinician, such as an anesthesiologist, radiologist, pathologist, or assistant surgeon, treating a patient at a hospital or ambulatory surgical center that is in the patient's network.

Can I use notice and consent to balance bill?

Only for certain services and only if federal notice and consent requirements are met. The Act doesn't allow it for ancillary services such as anesthesiology, pathology, radiology, and some others.

Can I dispute the payment?

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