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N906 Remark Code: Not Covered Under Age 45

N906 means the service is not covered because the patient was younger than 45 on the date of service. The payer's coverage rules set 45 as a minimum age for this service, which is common for some screening benefits.

Quick facts

Code
N906 (RARC N906)
Status
Active In use since March 1, 2025.
Code set
Remittance Advice Remark Codes (RARC)
Group codes
  • CO (Contractual Obligation): A denial the provider absorbs, for example when the date of birth was reported wrong or the patient was not told in advance about non-coverage.
  • PR (Patient Responsibility): The patient may be responsible when the plan excludes the service for their age and they were informed, subject to plan and program rules.
Official description
Service is not covered when patient is under age 45.
X12 Remittance Advice Remark Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What N906 means

Preventive and screening benefits are often tied to age ranges based on clinical guidelines. N906 says the payer’s rule for this service starts at age 45, and the patient’s date of birth shows they had not reached it on the date of service.

Common causes

  • The patient is under 45 and the service was billed as routine screening.
  • The date of birth in box 3 was entered incorrectly or differs from the payer’s record.
  • Diagnosis codes did not show the symptoms or risk factors that support earlier testing.
  • The payer’s policy does not cover the service at that age, regardless of risk.

How to fix it

  1. Confirm the date of birth against the patient’s insurance card and registration. If it was wrong, submit a corrected claim (frequency code 7).
  2. Review the diagnosis coding. If the service was diagnostic or the patient met high-risk criteria, correct the codes in box 21 and pointers in box 24E and resubmit.
  3. Appeal with documentation if the payer’s policy covers the patient’s situation.
  4. Bill the patient only when the plan excludes the service and your notice and consent processes allow it.

How to prevent it

Check age-based coverage rules during scheduling for screening services, and flag patients under the payer’s age threshold for a benefit check. Claims Validator can catch age-and-procedure conflicts before submission.

Codes that may appear with N906

  • CO-6 (The procedure/revenue code is inconsistent with the patient's age.): The procedure is inconsistent with the patient's age.
  • PR-204 (This service/equipment/drug is not covered under the patient's current benefit plan): The service is not covered under the patient's current benefit plan.
  • CO-96 (Non-covered charge(s).): A non-covered charge, with N906 giving the reason.
  • N30 (Patient ineligible for this service.): The patient is ineligible for this service, for a reason other than age.
  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Refers you to plan benefit documents for restrictions on the service.
  • CO-9 (The diagnosis is inconsistent with the patient's age.): The diagnosis, rather than the procedure, is inconsistent with the patient's age.

N906 FAQ

Which services have an age-45 rule?

Some screening benefits start at 45, for example colorectal cancer screening under current recommendations for average-risk adults. The exact services and ages depend on the payer's policy.

What if the patient is high risk?

Many policies cover earlier or diagnostic testing for patients with symptoms or higher risk. Make sure the diagnosis codes and documentation reflect that, and check whether the service should be billed as diagnostic rather than screening.

Can the patient be billed?

Only if the plan and program rules allow it and, where required, the patient was notified in advance that the service might not be covered.