PR-1Rarely worth appealing
PR-1: deductible amount — and why it is not a denial
Not a denial at all. The claim was covered, and this portion applies to the patient's deductible.
Deductible Amount
What the PR group code means
PR — Patient Responsibility
The amount moves to the patient — deductible, copay, coinsurance, or a non-covered service they agreed to.
Is it worth appealing?
There is nothing to appeal. The payer processed the claim correctly and assigned part of it to the patient. The only real question is whether the deductible was calculated correctly — and that is a patient-plan question, not an appeal.
Why payers issue PR-1
- 01The patient has not yet met the plan's annual deductible.
- 02The plan year reset and the deductible started over.
- 03The service applies to a separate deductible, such as one specific to a service category.
What to gather before you appeal
- The patient's benefit details, including deductible met to date.
- The remittance advice showing the allowed amount and the patient-responsibility split.
- Eligibility verification from the date of service.
Arguments that work
- Rarely applicable. If the deductible appears miscalculated, the route is a claims inquiry with the payer, not a formal appeal.
The deadline
The relevant clock here is your patient-billing cycle, not an appeal deadline.
Common questions about PR-1
- Can I bill the patient for PR-1?
- Yes. PR is the Patient Responsibility group code — that is precisely what it means. PR-2 (coinsurance) and PR-3 (copayment) work the same way. Unlike every CO code, these amounts are billable to the patient.
- Why does PR-1 show up in my denial reports?
- Because many reports lump every adjustment code together. PR-1 is not lost revenue — it is revenue that moved to the patient. Filtering it out usually makes a denial report far more useful.
Draft the PR-1 appeal in about three minutes
Upload the denial. Undeny reads it, drafts a payer-specific appeal letter citing this code and the record, and tracks the deadline until the money comes back.
Other denial codes
- CO-197CO-197 denial: prior authorization absent
- CO-16CO-16 denial: claim lacks information
- CO-29CO-29 denial: timely filing limit expired
- CO-45CO-45: charge exceeds fee schedule
- CO-50CO-50 denial: not deemed medically necessary
- CO-97CO-97 denial: service already included in another payment
- CO-18CO-18 denial: exact duplicate claim
- CO-22CO-22 denial: another payer is primary
- CO-27CO-27 denial: coverage terminated before the service
- CO-96CO-96 denial: non-covered charges
- CO-109CO-109 denial: claim sent to the wrong payer
- CO-151CO-151 denial: too many services billed
- CO-B7CO-B7 denial: provider not eligible on the date of service
- CO-4CO-4 denial: modifier inconsistent or missing
- CO-11CO-11 denial: diagnosis inconsistent with the procedure
- PR-204PR-204: not covered under the patient's benefit plan