Which denial codes appear with N130?

N130 commonly rides with PR 96, CO 97, CO 151. The adjustment code says the claim was reduced; the remark code says why.

Remark code

N130 denial code

The member's plan restricts this service, and the payer has pointed you at the benefit document instead of naming the restriction.

Find out which, first

A remark code is not the denial. The adjustment code says the claim was reduced. This one says why. You need both to know what to send back.

What to do

Pull the benefit document for that member's specific product, not the payer's general policy, and find the restriction. If the document does not contain one, ask the payer in writing to name it. A denial that cannot cite its own rule is worth appealing.

Codes it appears with

N130 commonly rides alongside these. Our reading, not a published mapping: X12 publishes no adjustment-to-remark table.

Code	What that one means
PR 96	Not a covered charge under this plan.
CO 97	The payer says this is already paid inside another service.
CO 151	The payer says the records do not support this many units or visits.

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