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PR-2 Denial Code: Coinsurance Amount

PR-2 means the amount shown is the patient's coinsurance, a percentage of the allowed amount that the plan requires the patient to pay. The payer processed the claim; this portion is billed to the patient or their secondary insurance.

Quick facts

Code
PR-2 (CARC 2)
Status
Active In use since January 1, 1995.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The normal use. The coinsurance is the patient's share and can be billed to the patient or to secondary coverage.
  • CR (Correction and Reversal): A correction or reversal of coinsurance posted on an earlier remittance, usually during reprocessing. Adjust the patient balance to match the new result.
  • CO (Contractual Obligation): Rare. Coinsurance under CO indicates the provider, not the patient, absorbs it, for example under a contract term. Verify with the payer before acting.
Official description
Coinsurance Amount
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-2 means

CARC 2 reports coinsurance: the patient’s percentage share of the allowed amount once any deductible is satisfied. It is a cost-sharing amount, not a rejection. The claim was adjudicated and priced; the payer is telling you how much of the allowed amount it expects the patient to cover.

Example for one service line:

ItemAmount
Billed charge$250.00
Allowed amount (CO-45 writes off $121.70)$128.30
Plan pays 80%$102.64
PR-2 coinsurance at 20%$25.66

Because it is a percentage, coinsurance usually lands on odd cent amounts, while a co-payment (PR-3) is typically a round figure.

Common causes of coinsurance questions

  • Out-of-network processing. Many plans apply a higher coinsurance rate for non-network providers. If you are contracted and see a higher rate, your provider or location may not be linked to the network correctly. See provider enrollment denials.
  • Wrong benefit category. Services may fall under a different benefit (for example specialist, outpatient facility, or behavioral health) with its own coinsurance.
  • Allowed amount differs from your contract. Coinsurance is based on the allowed amount, so an underpriced line also produces an understated coinsurance.
  • Out-of-pocket maximum. Once the patient reaches it, coinsurance should stop. PR-2 after the out-of-pocket maximum is met is worth a call.
  • Reprocessing. A later CR-2 can reverse coinsurance from an earlier ERA.

How to handle it

  1. Verify the allowed amount against your fee schedule or contract. If the allowed amount is wrong, the coinsurance is too.
  2. Check the rate against the patient’s benefits from the eligibility response.
  3. Bill secondary coverage first if the patient has any, attaching the primary ERA data. Medigap and Medicaid secondary coverage commonly respond to coinsurance.
  4. Bill the patient for any remaining PR-2 balance.
  5. Dispute errors with the payer. If the rate or benefit category is wrong, call provider services or submit a reconsideration. Use a corrected claim (resubmission code 7 in box 22) only if your own coding or place of service caused the problem.
  6. Post reversals carefully. When CR-2 appears, adjust or refund the patient balance so statements stay accurate.

How to prevent problems

  • Verify benefits before the visit, including coinsurance rate, network status, and remaining out-of-pocket maximum.
  • Estimate the patient share for higher-cost services and discuss it up front.
  • Keep payer fee schedules loaded so you can spot an incorrect allowed amount before billing the patient.
  • Report cost-sharing separately from denials. Coinsurance is expected revenue from the patient, not lost revenue. An ERA analysis that separates PR amounts from denials gives a truer picture of collections.

Remark codes that may appear with PR-2

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Directs you to the plan's benefit documents for how coinsurance applies to this service.
  • MA01 (Alert: If you do not agree with what we approved for these services, you may appeal our decision.): Standard Medicare appeal-rights alert on a processed claim, not a sign the coinsurance is wrong.
  • PR-1 (Deductible Amount): Deductible, which is applied before coinsurance starts.
  • PR-3 (Co-payment Amount): Co-payment, a flat dollar amount instead of a percentage.
  • PR-248 (Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.): Coinsurance for a professional service billed on an institutional claim.
  • CO-241 (Low Income Subsidy (LIS)): Low Income Subsidy co-payment, used in Medicare Part D contexts.
  • CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): Fee schedule reduction that sets the allowed amount the coinsurance percentage is based on.

PR-2 FAQ

How is PR-2 calculated?

The payer multiplies the allowed amount (after any deductible) by the plan's coinsurance rate. For example, 20% coinsurance on a $150 allowed amount is $30. That is why coinsurance amounts often have cents.

Can I bill the patient for PR-2?

Generally yes. It is patient responsibility. If the patient has secondary insurance, bill the secondary first, because it may pick up some or all of the coinsurance.

What does CR-2 mean on my ERA?

CR is the correction and reversal group. CR-2 reverses coinsurance posted on an earlier remittance, typically because the claim was reprocessed. Update the patient's balance to match the new adjudication.

Why is the coinsurance higher than I expected?

Common reasons are out-of-network processing, a different benefit category than you expected, or an allowed amount that differs from your fee schedule. Compare the ERA to the eligibility response and your contract.