No. PR-1 means the allowed amount was applied to the patient's deductible. The service was covered and the payer processed it correctly; the patient owes that amount until the deductible is met. PR-2 and PR-3 work the same way for coinsurance and copays.

How much should I bill the patient after PR-1, PR-2, or PR-3?

Bill the patient the sum of the PR amounts on the remittance, not your full charge. The difference between your charge and the allowed amount is a contractual adjustment, usually CO-45, which an in-network provider writes off. Bill any secondary plan first.

Patient responsibility codes: deductible, coinsurance, and copay

PR-1, PR-2, and PR-3 are among the most common codes on any remittance, and none of them is a denial. The service was covered and the payer allowed it; these codes record how much of the allowed amount is the patient's to pay. PR-1 is the amount applied to the patient's deductible, PR-2 their coinsurance percentage, and PR-3 a flat copayment. The patient owes these amounts, not the billed charge - the gap between the charge and the allowed amount is a contractual write-off, normally posted as CO-45.

Also described as: patient responsibility; applied to deductible; coinsurance amount; copay amount; PR adjustment.

The 3 codes and what separates them

PR-1 - Amount applied to the patient's deductible
The allowed amount, or part of it, went toward the patient's unmet deductible.
Who pays: Patient
PR-2 - Amount applied to the patient's coinsurance
The patient owes their coinsurance percentage of the allowed amount.
Who pays: Patient
PR-3 - Amount applied to the patient's copayment
The patient owes a fixed copayment for the visit or service.
Who pays: Patient

How to tell which one you have

Read them as a set. A single line can carry more than one: the deductible applied first, then coinsurance on what remains, with a copay on services the plan prices that way. Bill the patient the sum of the PR amounts, not the billed charge. If the patient has a secondary plan, send the claim there before billing the patient, because the secondary often picks up some or all of these amounts.

Frequently asked questions

Is PR-1 a denial?: No. PR-1 means the allowed amount was applied to the patient's deductible. The service was covered and the payer processed it correctly; the patient owes that amount until the deductible is met. PR-2 and PR-3 work the same way for coinsurance and copays.
How much should I bill the patient after PR-1, PR-2, or PR-3?: Bill the patient the sum of the PR amounts on the remittance, not your full charge. The difference between your charge and the allowed amount is a contractual adjustment, usually CO-45, which an in-network provider writes off. Bill any secondary plan first.

Other denial reasons

Out of network No prior authorization Not medically necessary Service not covered Bundled or not paid separately Coding mismatch or invalid code Patient not eligible or coverage ended Another payer is responsible Missing information, duplicate, or late filing Provider not eligible or not credentialed Benefit or unit limit reached Paid less than billed

Every denial code in one table

Last reviewed October 3, 2026.

These are original plain-English summaries written for reference, not the official X12 code descriptions. Payer handling of any code varies by contract - always verify against the remittance advice and your payer agreement before adjusting a claim.