N425 remark code

Remittance advice remark code N425. Remark codes add detail to the reason code on the same claim line.

Excluded by law

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What N425 means

The service is not covered because a statute excludes it from the program or plan.

N425 means the exclusion comes from law, not from a medical necessity decision. Some services are written out of a program's coverage entirely, so they will not be paid no matter how well documented.

It typically supports reason code 96 or 204. Patient responsibility often depends on the group code and on whether proper notice was given, so check both.

Common causes

• The service falls in a category the program is barred by law from covering.
• A routine or cosmetic service was billed to a program that excludes it.
• The item or service was billed under the wrong program.

What to do next

1. Confirm the code and diagnosis are correct and that the service really falls in the exclusion.
2. Check the group code to see who the payer assigned the balance to.
3. Review the patient's signed financial agreements before billing the patient.
4. Bill any secondary coverage that may include the service.

Related codes

• 96 (reason code) Service not covered by the plan
• 204 (reason code) Not covered under the patient's plan
• N130 (remark code) Check plan benefits for restrictions