CMS 2026 Alert: Quarterly ICD-10-CM & NCCI updates active.
N65 - Denial Journal
RARC

N65

Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider

What This Code Means

The payer’s system has no rate on file for this code, provider, and date combination.

Common Causes

  • New or recently updated code not yet loaded into the payer's fee schedule
  • Provider's contract terms don't include a rate for this code

How to Resolve or Appeal

  1. Confirm with the payer whether the code should have a rate on file
  2. Resubmit once the rate is loaded, or escalate to contracting

Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.

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