What is a PR 49 denial code?
Asked by: Mr. Abelardo Hartmann DDS | Last update: June 17, 2025Score: 4.7/5 (13 votes)
What does denial code PR mean?
PR (Patient Responsibility) is used to identify portions of the bill that are the responsibility of the patient. These could include deductibles, copays, coinsurance amounts along with certain denials. If the patient did not have coverage on the date of service, you will also see this code.
What is a CO94 denial code?
What is Denial Code 94. Denial code 94 means that the claim has been processed for an amount that exceeds the charges submitted. In other words, the insurance company has determined that the billed amount is higher than what they consider to be reasonable or appropriate for the services provided.
What does PR 50 mean?
A: This denial reason code is received when a procedure code is billed with an incompatible diagnosis for payment purposes, and the ICD-10 code(s) submitted is/are not covered under an LCD or NCD.
What does PR 49 mean?
Description. PR -49. This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
What is Denial Code CO 45?
Is PR 50 patient responsibility?
For example, reporting of reason code 50 with group code PR (patient responsibility) on the remittance should reflect: 1) the beneficiary received an ABN, 2) the beneficiary knew that Medicare would not cover the item or service in this particular situation because it was "not reasonable and necessary", 3) the ...
What is a PR 19 denial code?
Denial code 19 is used to indicate that the claim has been denied because the injury or illness is considered work-related and therefore falls under the responsibility of the Worker's Compensation Carrier.
What is the PR 55 denial code?
PR-55 Code – Invalid Procedure Code/Modifier Used Much like the PI-4 code, this code indicates a procedure or modifier inconsistency. Used when multiple surgeries or concurrent care lead to an adjustment in the billed amount. This denial emerges when there's an issue with the authorization number.
What is the CO 50 denial code?
CO 50, the sixth most frequent reason for Medicare claim denials, is defined as: “non-covered services because this is not deemed a 'medical necessity' by the payer.” When this denial is received, it means Medicare does not consider the item that was billed as medically necessary for the patient.
What is PR 100 denial?
Denial code 100 is when the payment is made directly to the patient, insured, or responsible party instead of the healthcare provider.
What is the PR 39 denial code?
Denial code 39 is used when services are denied because the authorization or pre-certification was requested at the time of service. This means that the healthcare provider did not obtain the necessary approval or verification from the insurance company before providing the services, resulting in the denial of payment.
What is a PR 58 denial code?
Denial code 58 means the treatment was done in the wrong place.
What is error code 49?
In general, a 49 service error is a situation where the printer cannot process a file that has been sent. In some cases the file is corrupted and in other cases the printer's firmware simply cannot interpret that file.
What is reason code 49?
Denial code 49 is used to indicate that a specific service is not covered by the insurance provider. In this case, it is because the service falls under the category of a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam.
What is code 49?
Germany Country Code 49 - Worldometer.
What does PR 49 denial code?
Routine Services
The Remittance Advice will contain the following codes when this denial is appropriate. PR-49: These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.
What does PR 45 denial code mean?
Denial code 45 is used when the charge for a service exceeds the fee schedule, maximum allowable amount, or the contracted/legislated fee arrangement. This means that the amount being charged for the service is higher than what is allowed or agreed upon by the payer.
What is PR 20 denial?
Denial code 20 means that the injury or illness being claimed is covered by the liability carrier. In other words, the healthcare provider's claim for reimbursement has been denied because the responsibility for payment lies with another party, such as an insurance company or a liability carrier.
What is a PR 21 denial code?
Denial Code CO-P21 signifies that the claim was denied because the documentation provided was incomplete or did not meet the payer's requirements. This can occur if crucial information or supporting documentation required to substantiate the claim is missing or insufficient.
What is a PR 16 denial code?
Denial code 16 means that the claim or service is missing necessary information or contains errors related to submission or billing.
What is a PR 25 denial code?
Denial code P25 is used when a payment is adjusted based on the Medical Provider Network (MPN). If the adjustment is at the claim level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF).
What is denial code PR 22?
Denial Reason PR-22 means that payment adjusted because this care may be covered by another payer per coordination of benefits.
What is PR code 50?
Assuming '50' is a CO-50 or PR-50, it means "These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present."
What is denial code PR 96?
Denial code 96 is for non-covered charges. It means that there is missing information in the claim, such as a remark code.