RARC N448: Service Not on Fee Schedule or Contract

What Does RARC N448 Mean?

RARC N448 indicates that the drug, service, or supply billed on the claim does not appear on the payer's fee schedule, contracted rate list, or any legislated fee arrangement. In practical terms, the payer has no established price or coverage policy for the billed code, which prevents it from processing the claim through its standard adjudication system.

This can happen for several reasons. The HCPCS or CPT code may be new and the payer has not yet added it to its fee schedule. The code may represent a service that is genuinely excluded from the patient's benefit plan. A miscoded claim — using the wrong procedure code — can also trigger N448 if the incorrect code happens to be one the payer does not recognize or cover. In some cases, the service is covered but must be billed differently, such as using a different code, billing through a different claim type (professional vs. institutional), or submitting under a different benefit category.

N448 does not always mean the service is permanently non-covered. For new codes or services, payers sometimes have a lag period before they establish pricing. For excluded services, it may be possible to obtain a single-case agreement or an exception from the payer if clinical necessity can be demonstrated.

What to Do

Verify that the correct CPT or HCPCS code was used for the service performed. If you used a recently released code, the payer may not have updated its system yet — contact the payer to ask whether the code has been added to the fee schedule or whether there is a recommended alternative code to use in the interim. If the code is correct and the service is not on the fee schedule, ask the payer whether the service is a plan exclusion or if it can be covered through a different billing pathway.

If the service is a plan exclusion, determine whether the patient was notified of their financial responsibility before the service was provided (via an ABN for Medicare or a financial responsibility form for commercial payers). If the code was simply wrong, correct it and resubmit. For services that are covered but require a different billing method, follow the payer's instructions to resubmit under the correct format.

Common Scenarios

• A new HCPCS code released in the January quarterly update is billed to a payer that has not yet added the code to its fee schedule, resulting in N448
• A provider bills a CPT code for a service that is specifically excluded from the patient's commercial plan benefit package
• A claim uses a miscellaneous or unclassified HCPCS code (such as J3490 for an unclassified drug) without the supporting documentation the payer needs to establish a price

Commonly Paired With

RARC N448 commonly appears alongside these CARC denial codes: