Not covered in this place of service
The payer does not cover this service in the setting shown on the claim.
Usual causes
- Site-of-care policy (for example certain infusions or imaging not covered in a hospital outpatient setting).
- Telehealth service not covered from this location.
- Wrong place of service code.
The fix
Correct the place of service if it was wrong. Otherwise appeal with the clinical reason the setting was needed, or obtain site approval before the next service.
Appeal or corrected claim?
Corrected claim or appeal, depending on the cause.
Deadline to watch
Timely filing or appeal window.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
N428 in short
What does N428 mean?
The payer does not cover this service in the setting shown on the claim. The official X12 text reads: "Not covered when performed in this place of service."
What usually causes a N428 denial?
Site-of-care policy (for example certain infusions or imaging not covered in a hospital outpatient setting). Telehealth service not covered from this location. Wrong place of service code.
How do I fix N428?
Correct the place of service if it was wrong. Otherwise appeal with the clinical reason the setting was needed, or obtain site approval before the next service.
Should I appeal N428 or send a corrected claim?
Correct or appeal (see note). Corrected claim or appeal, depending on the cause.
What deadline applies to N428?
Timely filing or appeal window.