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PR-1 Denial Code: Deductible Amount

PR-1 means the payer applied some or all of the allowed amount to the patient's annual deductible. The claim was processed correctly, but that portion is the patient's responsibility, so you bill the patient rather than the insurer.

Quick facts

Code
PR-1 (CARC 1)
Status
Active In use since January 1, 1995.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The standard use. The deductible amount is patient responsibility and can be billed to the patient or their secondary coverage.
  • CO (Contractual Obligation): Uncommon. A deductible reported under CO suggests the provider is responsible, for example where a contract waives cost-sharing. Confirm with the payer before writing it off or billing anyone.
Official description
Deductible Amount
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-1 means

CARC 1 is the deductible amount: the part of the allowed amount the patient must pay before their plan starts sharing costs. Because it almost always comes with the PR (patient responsibility) group code, the ERA is telling you two things: the claim was accepted and priced, and this amount should be collected from the patient (or from secondary coverage).

A worked example on one service line:

  • Billed charge: $180
  • Allowed amount: $110, so CO-45 writes off $70
  • Patient has $400 left on their deductible, so the full $110 goes to PR-1
  • Payer paid: $0

If the patient had only $50 of deductible left, the ERA would show PR-1 for $50, and the remaining $60 would be split between the payer’s payment and any coinsurance (PR-2).

Common causes

PR-1 is normal plan behavior rather than a billing error, but these situations tend to create questions:

  • Start of the plan year. Deductibles reset, so claims in the first months of a plan year often go entirely to the deductible.
  • High-deductible health plans. Patients on HDHPs can owe the full allowed amount for many visits.
  • Separate in-network and out-of-network deductibles. A service processed as out-of-network may hit a larger, separate deductible.
  • Claim order. When several claims arrive together, the payer applies the deductible to whichever it processes first, which may not be the earliest date of service.
  • Deductible applied to a service that should not have one. Some plans cover certain preventive services with no cost-sharing. If PR-1 appears on those, the coding or benefit setup may be off.

How to handle it

  1. Confirm the math. Check that the PR-1 amount does not exceed the allowed amount and that the allowed amount matches your fee schedule.
  2. Check for secondary coverage. If the patient has another plan, submit the claim with the primary ERA to the secondary payer before billing the patient. See coordination of benefits denials.
  3. Bill the patient for the PR-1 amount, showing the payer’s adjustment so the balance is easy to understand.
  4. Question it if it looks wrong. If the service should have had no deductible, or the patient’s met-to-date amount does not add up, call the payer and ask for reprocessing. If a coding error caused it (for example, a preventive service coded as diagnostic), submit a corrected claim with resubmission code 7 in box 22.
  5. Refund if needed. If a later adjustment reverses the deductible, refund any overpayment the patient made.

How to prevent surprises

  • Run an eligibility check before the visit and note the deductible and amount met to date. Deductible status changes daily as other claims post.
  • Give estimates to patients on high-deductible plans and collect a reasonable deposit where your policy allows.
  • Collect card-on-file or payment plan details at check-in for patients early in their plan year.
  • Track deductible dollars separately from denials. PR-1 is not a denial, and mixing it into denial reporting hides real problems. See how to read CARC and RARC codes.

Remark codes that may appear with PR-1

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Points to plan benefit documents, sometimes when the deductible applies differently to this type of service.
  • MA01 (Alert: If you do not agree with what we approved for these services, you may appeal our decision.): Medicare appeal-rights alert that often prints on processed claims; it does not mean the deductible was applied in error.
  • PR-2 (Coinsurance Amount): Coinsurance: the percentage the patient owes after the deductible is met.
  • PR-3 (Co-payment Amount): Co-payment: a fixed dollar amount per visit rather than an amount applied to the deductible.
  • PR-66 (Blood Deductible.): Blood deductible, a separate deductible for units of blood under some plans, mainly Medicare.
  • PR-247 (Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.): Deductible for a professional service billed on an institutional claim.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): The contractual write-off that usually appears on the same line, before the deductible is applied.

PR-1 FAQ

Is PR-1 a denial?

No. PR-1 means the claim was processed and the allowed amount went toward the patient's deductible. The payer simply paid less, or nothing, because the deductible was not yet met.

Can I bill the patient for a PR-1 amount?

Yes, in most cases. PR-1 is patient responsibility. If the patient has secondary coverage, send the claim to the secondary payer first, since it may cover some or all of the deductible.

Why did the payer pay $0 when PR-1 appears?

If the allowed amount is less than the deductible remaining, the entire allowed amount is applied to the deductible and the payer pays nothing. This is common early in a plan year and with high-deductible health plans.

Can a PR-1 amount be wrong?

Yes. The payer might have processed claims out of order, applied an in-network service to an out-of-network deductible, or applied a deductible to a service the plan covers at no cost-sharing, such as some preventive care. Check the eligibility response and call the payer if it does not match.