PR-2 Denial Code: Coinsurance Amount (Patient Responsibility)

PR-2 is Claim Adjustment Reason Code 2 with group code PR. CARC 2 means “Coinsurance Amount.” Coinsurance is the patient’s percent share of the allowed amount after the deductible. With group PR, you can usually bill secondary coverage or the patient. The same CARC with group CO is CO-2. CO-2 means a contract write-off under CMS group-code rules. Before this page existed, a WordPress 404 guess sent /denial-codes/pr-2/ to PR-204. PR-204 means the service is not covered under the current benefit plan. That is not coinsurance. Many people search for “pr 2 denial code” or “denial code pr 2”, and those are the phrases this page answers. (Primary sources: X12 Claim Adjustment Reason Codes · CMS Claims Processing Manual, Ch. 22, §60.1 · PR-1 / PR-2 / PR-3 · CO-2)

Quick answer: PR-2 is the patient’s coinsurance share of the allowed amount. Post it as patient responsibility, bill secondary or Medicare supplemental when applicable, then statement the patient for any remaining balance. Do not confuse it with PR-204 (benefit not covered) or with CO-2 (same CARC, provider write-off).

Part of our denial codes library. Written by Manikandan, a revenue cycle management specialist with more than 10 years of US medical billing experience. Last reviewed: 14 October 2026. Official code wording is quoted word for word from X12; Medicare rules link to their CMS source. For the full deductible / coinsurance / copay trio, see our PR-1, PR-2, PR-3 guide.

PR-2 denial code description (official X12 wording)

X12 Claim Adjustment Reason Code 2, verbatim:

“Coinsurance Amount”

Source: X12 Claim Adjustment Reason Codes, checked 14 October 2026. Start: 01/01/1995. No later “Last Modified” date is listed for code 2.

The CARC is 2. Coinsurance is a percentage of the allowed amount (for example one-fifth after the deductible). The group code decides who owns the dollars: PR-2 (patient) vs CO-2 (provider write-off).

What PR-2 means in plain English

• The payer calculated the member’s coinsurance on the allowed amount.
• PR means patient share. CMS says that amount may be billed to the patient or insured.
• PR-2 is cost-sharing. It is not a medical-necessity denial.
• PR-2 is not a non-covered denial. The service usually paid in part.
• CO-2 is the contract twin of the same CARC.
• PR-204 means the service is not covered under the current benefit plan. That is different from coinsurance.

PR-2 vs CO-2, PR-1, PR-3, PR-204 and lookalikes

Code	Official X12 idea	What it tells you
PR-2	Coinsurance Amount (group PR)	Patient percent share — this page
CO-2	Coinsurance Amount (group CO)	Same CARC, contract write-off — CO-2
PR-1	Deductible Amount (group PR)	Patient deductible — PR-1 / PR-2 / PR-3
PR-3	Co-payment Amount (group PR)	Fixed-dollar copay — same trio guide
PR-204	Service/equipment/drug not covered under current benefit plan	Benefit exclusion — PR-204
45	Charge exceeds fee schedule / contracted amount	Pricing cut often next to PR-2 — CO-45
22	Care may be covered by another payer per COB	Coordination of benefits — CO-22

Group code matrix for CARC 2

Group + 2	Who carries the amount	Typical next step
PR-2	Patient / insured (billable after secondary)	Bill secondary or patient; see PR-1 / PR-2 / PR-3
CO-2	Provider (write-off under the contract)	Post contract adjustment; do not statement the patient — CO-2
OA-2	Other adjustment	Read remarks; confirm it is not a mis-grouped PR

CMS Ch. 22 §60.1 says PR is for amounts that “may be billed to the patient or insured” and “would typically be used for deductible and copay adjustments.” Coinsurance follows the same patient-share pattern when the group is PR.

When you see PR-2 on a remit

1. Standard commercial coinsurance. After the deductible, the plan pays its share (for example, eighty percent) and reports the member share (often one-fifth) as PR-2.
2. Medicare Part B coinsurance. Original Medicare typically applies a one-fifth coins share after the Part B deductible. Remits show that share as PR-2. Related specialty CARCs appear only in narrow bundling cases.
3. Next to CO-45. Allowed amount is cut to the fee schedule (CO-45), then coinsurance is calculated on the allowed amount and posted as PR-2.
4. Not automatic write-off. If your contract says the provider absorbs member coinsurance, you would expect CO-2, not PR-2 — investigate if the group looks wrong.

Where PR-2 shows up in the 835

CLP*PCN44556*1*220.00*112.00*88.00*12*CLAIM990011~
SVC*HC:99214*220.00*112.00**1~
CAS*CO*45*80.00~
CAS*PR*2*28.00~
AMT*B6*140.00~

• Allowed amount $140 (charge $220 minus CO-45 $80).
• Plan paid $112 (four-fifths of allowed).
• CAS*PR*2*28.00 is the one-fifth patient coinsurance.
• If the same $28 were absorbed by contract, you would expect CAS*CO*2 instead.

Sample only. Real remits vary by payer and may add remark codes.

How to fix / work PR-2: decision path

1. Confirm the CAS segment. Group PR, reason 2, and dollar amount. Save the 835/EOB.
2. Recalculate. Allowed × coinsurance rate should match PR-2 (after deductible logic).
3. Bill secondary or supplemental (Medigap, Medicaid secondary, commercial secondary) with the primary EOB before stating the patient.
4. If secondary pays or adjusts, post their remit; only the leftover patient share remains.
5. If the group should have been CO (contract absorbs coinsurance), ask payer services to reprocess as CO-2 — do not silently write off PR-2 without records.
6. If the amount looks like a full denial, check whether the payer meant PR-204 or another non-covered CARC; compare the EOB narrative.
7. Apply billing policy for true patient balances (statements, payment plans) only after secondary is exhausted.
8. Never rebrand PR-2 as a non-covered denial just because the slug once redirected to PR-204.

Medicare, commercial and Medicaid notes

Medicare (Original). Part B coinsurance is normally PR-2 after the annual Part B deductible (PR-1). CMS set the 2026 Part B deductible at $283 (CMS, 2026) (CMS 2026 fact sheet). Most Medigap plans cover Part B coinsurance. Bill secondary before the patient.

Commercial. Read the ID card and EOB for the coinsurance percentage (for instance, one-tenth to two-fifths after deductible). Network vs out-of-network rates change the PR-2 math.

Medicaid. Many state Medicaid programs have little or no coinsurance. A PR-2 line may be a mis-group or a dual-eligible crossover artifact. Verify before billing the member.

Worked example (illustrative)

Allowed amount $200. Plan coinsurance one-fifth. Remit pays $160 and shows CAS*PR*2*40.00.

Prevention checklist

• [ ] Always read group + CARC + amount together.
• [ ] Default mental model: coinsurance → expect PR-2; investigate CO-2.
• [ ] Automate secondary billing when PR-2 posts.
• [ ] Map PMS rules so PR-2 never auto-writes-off as contract.
• [ ] Know PR-1 / PR-2 / PR-3 and CO-2.
• [ ] Do not confuse PR-2 with PR-204 (benefit not covered).
• [ ] Use the CARC and RARC guide for training.

Related denial codes

• PR-1 / PR-2 / PR-3: combined patient-share deductible, coinsurance and copay guide.
• CO-2: coinsurance amount with group CO.
• CO-1 / CO-3: deductible / copay under group CO.
• PR-204: not covered under current benefit plan (old wrong redirect).
• CO-45: charge above fee schedule / contracted amount.
• CARC and RARC guide.

Key takeaways

Keep this short: coinsurance is a percent of the allowed amount. CARC 2 means coinsurance amount. PR-2 is the usual billable to the patient form. Bill secondary first, then the patient. CO-2 is the write-off twin. PR-204 is a non-covered benefit code — not coinsurance — even though an old redirect once mixed the URLs.

FAQ

Quick facts

Item	Value
X12 code	2
X12 start	01/01/1995
Official wording	Coinsurance Amount
Usual group for patient coinsurance	PR
This page’s group focus	PR
Contract twin	CO-2
Old wrong redirect	PR-204
Last reviewed	14 October 2026

Sources

• X12, Claim Adjustment Reason Codes (CARC 1, 2, 3, 22, 45, 204). CARC 2 Start 01/01/1995. Accessed 14 Oct 2026.
• CMS, Medicare Claims Processing Manual (IOM 100-04), Ch. 22, §60.1 Group Codes. Accessed 14 Oct 2026.
• CMS, 2026 Medicare Parts A & B Premiums and Deductibles. Part B deductible $283. Accessed 14 Oct 2026.
• Medical Billing 101, PR-1 / PR-2 / PR-3 guide.
• Medical Billing 101, CO-2 guide.
• Medical Billing 101, PR-204 guide.

Code wording and Medicare rules on this page were checked on 14 October 2026 against X12 and CMS sources.

Last reviewed: 14 October 2026 · This page is educational and doesn’t replace payer-specific contracts or benefit booklets.