N864 remark code

Remittance advice remark code N864. Remark codes add detail to the reason code on the same claim line.

No Surprises Act emergency rules apply

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 N864 means

An alert that the claim was processed under the No Surprises Act provisions that protect patients receiving emergency services.

N864 is an informational alert. It tells you the payer applied the emergency services rules of the No Surprises Act. Patient cost sharing is usually limited to in-network levels, and balance billing is generally not allowed.

The reason codes on the claim explain the payment itself. Disputes over the amount go through the federal negotiation and dispute process.

Common causes

• An out-of-network provider or facility treated a patient for an emergency.
• Post-stabilization care was treated as part of the emergency under the rules.
• The claim was flagged as emergency based on place of service or claim codes.

What to do next

1. Bill the patient no more than the PR amount on the remittance.
2. Check that the claim was correctly identified as emergency care.
3. Start open negotiation within the federal timelines if the payment is too low.
4. Make sure collection staff know this account is protected from balance billing.

Related codes

• N859 (remark code) No Surprises Act applied
• N830 (remark code) Balance billing protections apply
• N130 (remark code) Check plan benefits for restrictions