RARC N180: Service Does Not Meet Billed Category Criteria

The item or service does not meet the payer's criteria for the category under which it was billed (e.g., preventive, diagnostic, or surgical). This often means the procedure, diagnosis, or patient criteria are misaligned with the coverage guidelines for that category. Review the billing category, verify it matches the service provided and the payer's policy, and resubmit under the correct category with supporting documentation.