What is remark code N54?
N54 is a remark code meaning the claim doesn't match what was authorized: a different code, number of units, date range or provider from the approval on file.
Authorization against claim
| Field | Authorized | Billed |
|---|---|---|
| Procedure | 72148 MRI lumbar, without contrast | 72149 MRI lumbar, with contrast |
| Units | 1 | 1 |
| Dates | Feb 1 to Feb 28 | Feb 12 |
- Contrast was added during the visit, so the code changed and the authorization no longer covers it. Most payers let the provider update the authorization within a few days; after that, it's an appeal.
N54 is a remark code: it reads Claim information is inconsistent with pre-certified/authorized services. It usually comes with CO-198 or CO-197 and narrows the problem down to a mismatch, not a missing authorization.
Typical mismatches
- The procedure changed during the visit, such as adding contrast or another view.
- The rendering provider or facility differs from the one on the authorization.
- The units or dates fall outside the approved range.
How to fix it
Find the field that doesn’t match. If the claim is wrong, correct and resubmit it. If the service changed for a good clinical reason, ask the payer to update the authorization, which many allow for a short time after the service. If neither works, appeal with the records that explain the change.
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