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PR-1 - Denial Journal
CARC PR — Patient Responsibility

PR-1

Deductible amount

What This Code Means

The amount applied is the patient’s plan deductible — the portion of costs the patient must pay before the plan begins paying.

Common Causes

  • Patient hasn't met annual deductible yet
  • Deductible resets at start of new plan year

How to Resolve or Appeal

  1. Verify deductible status before the visit when possible
  2. Bill the patient for the deductible amount per your financial policy
  3. Confirm the accumulator matches what the patient's portal shows

More Denial Codes to Check

CARC CO-139 Contracted funding agreement — subscriber employed by the provider of services CARC CO-49 Non-covered: routine/preventive exam or screening performed with a routine exam CARC CO-202 CARC CO-B1 RARC M90 RARC MA55 CARC PR-204 Service/equipment/drug not covered under the patient's current benefit plan CARC CO-303 CARC CO-160 RARC MA13 Alert: possible penalties for billing the patient amounts not reported with the PR group code

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

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