PR-2 Denial Code: Coinsurance Amount
The PR-2 code means the amount is the patient's coinsurance - the percentage of the allowed amount the patient owes after the deductible is met (for example, 20% under Medicare Part B). Like the other PR cost-share codes, it is not a denial: the claim paid, and PR-2 is simply the patient's calculated share.
Common Causes
- Standard benefit design - the plan pays its percentage and the patient owes the rest (Medicare Part B's 20% is the most familiar example)
- Services subject to coinsurance rather than a flat copay under the patient's plan
- No supplemental or secondary coverage on file to pick up the coinsurance
How to Fix PR-2
- Post the PR-2 amount to patient responsibility and bill the patient - no claim correction is involved
- If the patient has supplemental or secondary coverage (Medigap, Medicaid, a second commercial plan), submit the coinsurance to it before billing the patient
- Confirm crossover claims went to the supplemental payer automatically; if not, file them
- For dually eligible Medicare/Medicaid patients, follow state rules on balance billing - the coinsurance often cannot be collected from the patient
Frequently Asked Questions
PR-2 means the amount is the patient's coinsurance - their percentage share of the allowed amount under the plan's benefit design. The claim itself processed and paid normally.
First check for secondary or supplemental coverage - Medigap and Medicaid commonly pay Medicare coinsurance, and many claims cross over automatically. Bill the patient only after any secondary payer has processed, and never bill dually eligible patients amounts that state Medicaid rules prohibit.
Related Denial Codes
Related Resources
Claim adjustment reason codes and remittance advice remark codes are standardized code sets maintained by X12. The explanations on this page are written in our own words for educational purposes, based on public CMS and Medicare contractor documentation. Payer policies vary - always confirm handling with the specific payer's guidance and your contracts.