N153 | Adjustment based on coverage

Industry

Healthcare

Canonical

/healthcare/error-codes/n153/

Last Updated

Feb 25, 2026

Summary

This code indicates that an adjustment was made based on coverage rules.

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What This Code Means

N153 is used when payer coverage policies result in an adjustment to the claim. The remark clarifies that coverage criteria influenced payment. It does not independently deny the service. The code supports other adjustment or responsibility indicators. Coverage rules vary by plan.

Where Users Usually See This Code

Remittance advice remarks
EOB explanations
Coverage adjustment summaries

Why This Code Appears

Coverage limitations applied
Benefit design rules enforced
Plan-specific policies affected payment

What Typically Happens Next

Payment is adjusted
Claim processing completes
Responsibility is assigned per policy

What This Code Is Not

It is not a billing error
It is not a documentation request
It is not a system malfunction

Troubleshooting Checklist

□ Review coverage rules
□ Confirm benefit applicability
□ Monitor plan changes

Notes And Edge Cases

Coverage adjustments may differ between primary and secondary payers. Plan year changes can affect outcomes.

Related Codes

8 links

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