Skip to main content

PR-126 Denial Code (Deactivated): Major Medical Deductible

PR-126 reported the deductible under a major medical benefit. X12 deactivated it and its notes instruct payers to use Group Code PR with CARC 1 instead.

X12 deactivated CARC126 on April 1, 2008. Payers should no longer use it on new remittances, but it can still appear on older ERAs, corrected claims, and appeals.

Quick facts

Code
PR-126 (CARC 126)
Status
Deactivated StoppedApril 1, 2008 (in use since February 28, 1997).
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The deductible was the patient's responsibility, which is why X12 pointed to the PR group.
Official description
Deductible -- Major Medical
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-126 meant

Older health plan designs sometimes layered a major medical benefit on top of a basic benefit. Each layer could have its own deductible. CARC 126 identified money applied to the deductible of the major medical layer, as distinct from the plan’s basic deductible. Although this page is labeled PR-126, the amount was patient cost-sharing.

What replaced it

X12’s notes are specific: use Group Code PR with code 1. So PR-1 is the replacement, reporting any deductible amount regardless of which benefit layer it came from. The active CO-102 still exists for major medical adjustments other than deductible, and coinsurance under any layer is PR-2.

If you still see PR-126

It will turn up only in historical data. Post it the same way as PR-1: move the amount to the patient’s balance. If a remittance showed it under the CO group, check with the payer before billing, since the group code determines who owes the amount and a CO label on a deductible is unusual.

  • PR-1 (Deductible Amount): Named replacement when used with group PR: deductible amount.
  • CO-102 (Major Medical Adjustment.): Major medical adjustment, still an active code.
  • PR-2 (Coinsurance Amount): Coinsurance amount, the usual next layer of patient cost-sharing.

PR-126 FAQ

What is a major medical deductible?

Some plans had a base benefit plus a separate major medical benefit with its own deductible. PR-126 showed the amount applied to that second deductible.

Can I bill the patient for a PR-126 amount?

Yes, generally. It was deductible, which is patient cost-sharing, and X12's replacement instruction is PR-1.