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N905 Remark Code: Opted-Out Provider, Patient Not Liable

N905 means the payer's records show the provider has opted out of Medicare, agreeing with the patient not to bill Medicare, so it cannot pay the claim. Unlike similar opt-out remarks, N905 states the patient is not responsible for payment.

Quick facts

Code
N905 (RARC N905)
Status
Active In use since March 1, 2025.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): The full denied amount, which the remark assigns to the provider rather than the patient.
Official description
Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is not responsible for payment.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N905 means

Practitioners who opt out of Medicare agree not to bill Medicare and instead contract privately with Medicare beneficiaries. When a claim arrives from a practitioner that Medicare’s records show as opted out, Medicare will not pay it.

Three remarks share nearly identical opt-out language. What sets N905 apart is the last sentence: it tells you the patient is not responsible. MA47 says the opposite, and MA56 says the patient is responsible but caps what you can charge.

Common causes

  • The rendering practitioner has an active opt-out affidavit on file.
  • A practitioner who previously opted out rejoined Medicare, but the enrollment record was not updated for the date of service.
  • The wrong rendering NPI was reported in box 24J, pointing to an opted-out colleague.
  • An opted-out practitioner submitted a claim without the circumstances that allow it.

What to do

  1. Verify the rendering NPI on the claim. If it was wrong, submit a corrected claim with the right practitioner.
  2. Check the practitioner’s Medicare enrollment status for the date of service with the MAC.
  3. Correct enrollment errors through the enrollment process, then ask for reprocessing.
  4. Do not bill the patient for this claim while the remittance says they are not responsible.

How to prevent it

Track opt-out affidavits and their effective dates for every practitioner, and block Medicare claims for opted-out practitioners at charge entry. See provider enrollment denials.

Codes that may appear with N905

  • CO-B7 (This provider was not certified/eligible to be paid for this procedure/service on this date of service.): The provider was not certified or eligible to be paid for the service on this date.
  • CO-185 (The rendering provider is not eligible to perform the service billed.): The rendering provider is not eligible to perform the service billed.
  • MA47 (Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.): Same opt-out explanation, but states the patient is responsible.
  • MA56 (Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.): Opt-out explanation where the patient is responsible, subject to the limiting charge.
  • CO-111 (Not covered unless the provider accepts assignment.): Not covered unless the provider accepts assignment.

N905 FAQ

What does it mean to opt out of Medicare?

An opted-out physician or practitioner files an affidavit with Medicare and enters private contracts with Medicare patients. For the opt-out period, neither the practitioner nor the patient submits claims to Medicare for covered services, except in limited situations.

Why would the patient not be responsible?

The remark does not explain the reason. It indicates the payer's determination for this claim, so do not bill the patient based on this remittance without first reviewing the circumstances with your compliance advisor.

What if we never opted out?

Contact your Medicare Administrative Contractor and check your enrollment record. An incorrect opt-out status must be corrected in the enrollment system before claims can pay.