PR-247 is not a denial in the usual sense. It is a deductible. It shows the patient’s Part B deductible for doctor services that Medicare paid inside a hospital’s bundled payment, so the amount sits on the hospital’s institutional claim instead of a physician claim. (Primary source: X12 Claim Adjustment Reason Codes)
In brief: CARC 247 reads “Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.” With group code PR, the patient or a secondary plan owes it. Post it as a deductible, not a write-off.
Part of our denial codes library. Written by Manikandan J, CPC, CRCR, who has built payment posting rules and crossover workflows for hospital billing teams. Published 26 October 2026. Last updated: 26 October 2026. Code wording quoted word for word from X12. Read about the author and our editorial policy, or contact us to report an error.
X12 entry
| Field | Value |
|---|---|
| Code | 247 |
| Description | “Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.” |
| Start | 09/30/2012 |
| Notes | For Medicare Bundled Payment use only, under the Patient Protection and Affordable Care Act (PPACA). |
Source: X12 Claim Adjustment Reason Codes, checked 26 October 2026. CMS added CARC 247 and 248 in CR 8154.
Key terms: A CARC is a Claim Adjustment Reason Code from the X12 list, and it says why a line was paid differently than billed. A RARC is a Remittance Advice Remark Code that adds detail. The group code is the two-letter prefix; PR means patient responsibility, so the amount can be billed to the patient or a secondary plan. A crossover is the claim Medicare forwards to a supplemental or Medicaid payer.
Methodology: the code wording above is copied from the X12 list, and the Medicare rules below come from the CMS change request that created this code.
Example scenario (fictional names), part 1
PR-247 Denial Example: What Happened
Dana Whitfield leads payment posting at Harlow Valley Hospital, a fictional hospital in Indiana. The team is moving to a new billing system and testing old 835 files from 2018, when the hospital took part in a Medicare bundled payment model.
One test remit showed a stay with CAS*PR*247*150 and CAS*PR*248*96. The new system had no rule for those codes. It put both amounts in the contractual write-off bucket, as if the hospital owed them. That is a PR-247 denial code read the wrong way.
Should Dana let the new system write off PR-247 amounts? Keep reading, or jump to how the PR-247 denial was resolved.
Where CARC 247 comes from
- Medicare’s Model 4 bundle. Under BPCI Model 4, CMS paid the hospital one prospective payment that covered the hospital and the doctors for the whole inpatient stay (CMS BPCI overview).
- No-pay doctor claims. Physicians still sent claims for those days, but Medicare processed them as no-pay, often with RARC N67, “Professional provider services not paid separately.”
- Part B cost share moved. The fixed Part B amount in the bundle went first to the Part B deductible. The patient also owed a fixed Part B copayment. Both show on the hospital’s claim (CMS CR 8070, Transmittal 1251).
- Two new codes. CMS asked for one CARC for the Part B deductible on a Part A claim (247) and one for the Part B coinsurance on a Part A claim (248).
Is PR-247 still used in 2026?
Rarely. CMS extended BPCI to September 30, 2018 for Model 2, 3 and 4 awardees, and as of July 1, 2018 Model 4 had 2 participants (CMS BPCI page). The code itself has no stop date on the X12 list. So you will mostly meet it in old remits, audits, system conversions, and crossover files. If a non-Medicare payer sends it today, ask what it meant, since X12 limits it to Medicare bundled payment.
Posting a PR-247 adjustment step by step
- Confirm the bundle. Check that the claim is a bundled inpatient stay. Look for remark codes such as N568 or M137 on the same remit.
- Post it as patient share. Map CARC 247 to the deductible bucket, like PR-1. Map 248 to coinsurance, like PR-2.
- Let the crossover carry it. On outbound crossover claims, CMS reports value code Y5 for the Part B deductible and Y3 for the Part B coinsurance on a Part A claim (CR 8070).
- Bill the right party. Send the balance to the secondary plan first. Bill the patient only for what is left.
- Watch Medicaid crossovers. For example, Missouri’s MO HealthNet tells hospitals to pick bundled value code Y5 for PR-247 and Y3 for PR-248 when they enter a Part A crossover (MO HealthNet tip).
Claim form note
No claim form visual is shown. PR-247 is a cost share on a correct bundled claim. The fix is in payment posting and the crossover, not in a CMS-1500 or UB-04 field.
Example scenario (fictional names), part 2
How the PR-247 Denial Was Resolved
Dana pulled the 2018 Medicare remit and the crossover record for the stay.
- The remit showed N568 on the stay, so it was a bundled Model 4 claim.
- The PR group meant the $150 and $96 were patient shares, not hospital losses.
- The old system had sent both to the supplemental plan with Y5 and Y3.
Fix: Dana mapped CARC 247 to the deductible bucket and 248 to coinsurance, both routed to secondary billing. No claim was changed, since the claim had been right.
Outcome: The test file posted with $0 in write-offs and the right secondary balance. Dana added both codes to the conversion test list so that rare codes get checked.
Names and details are illustrative; no real patient data.
Related codes
| Code | Meaning | Where to start |
|---|---|---|
| PR-247 | Part B deductible on a bundled hospital claim | Post as deductible |
| PR-248 | Part B coinsurance on a bundled hospital claim | Post as coinsurance |
| PR-1 | Deductible | Patient or secondary |
| PR-2 | Coinsurance | Patient or secondary |
| CO-249 | Readmission | Same CMS bundle rules |
FAQ
What does PR-247 mean?
It is the Part B deductible for doctor services paid in a Medicare bundled hospital claim.
Is PR-247 a denial?
No. It is a patient share. Post it as a deductible, not a write-off.
Who pays PR-247?
The patient or a secondary plan, such as Medicaid or a supplement.
How is PR-247 different from PR-1?
PR-1 is any deductible. PR-247 is only the Part B deductible on a bundled hospital claim.
Will I see PR-247 today?
Rarely. Model 4 ended in 2018, so it shows up mostly in old files and audits.
Sources
How we checked: the CARC 247 quote was matched word for word with the X12 CARC list on 26 October 2026, and the N67 remark with the X12 RARC list.
- X12, Claim Adjustment Reason Codes (CARC 247). Accessed 26 Oct 2026.
- X12, Remittance Advice Remark Codes (RARC N67, N568, M137). Accessed 26 Oct 2026.
- CMS, CR 8070 (Transmittal 1251), BPCI Model 4 implementation phase 3. Accessed 26 Oct 2026.
- CMS, CR 8154 code update with CARC 247 and 248. Accessed 26 Oct 2026.
- CMS, BPCI initiative general information. Accessed 26 Oct 2026.
- MO HealthNet, Bundled value code for Medicare UB-04 Part A claims. Accessed 26 Oct 2026.
Last updated: 26 October 2026 · Educational content; not legal advice.