← Back to Code Directory
CARC
PR-204
CARC
PR — Patient Responsibility
Non-Covered
Quick Facts
Code
PR-204
Type
CARC
Category
Non-Covered
Status
Active
Service/equipment/drug not covered under the patient's current benefit plan
What Does This Code Mean?
The specific service, item, or drug is excluded from the patient’s benefit plan, and the balance is the patient’s responsibility.
Common Causes
- Plan-specific exclusion (patient responsibility version of CO-96)
- Patient selected a plan tier that excludes this benefit
Recommended Next Steps
- Confirm the exclusion applies specifically to this plan tier
- Notify the patient in advance for elective/scheduled services when possible
- Bill the patient per your financial policy
Recently Viewed
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.