PR-2
Coinsurance amount
What This Code Means
The amount applied is the patient’s coinsurance — their percentage share of the allowed amount after the deductible is met.
Common Causes
- Standard plan cost-sharing structure
- Coinsurance percentage varies by service type or network status
How to Resolve or Appeal
- Confirm the coinsurance percentage matches the patient's plan summary
- Bill the patient their coinsurance share
- Flag repeated high coinsurance balances for the patient's own review with their plan
More Denial Codes to Check
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.