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PR-247 Code: Deductible on Institutional Bundled Claim

PR-247 reports the deductible amount for a professional service rendered in an institutional setting and billed on an institutional claim. X12 notes it is for Medicare bundled payment use only, under the Affordable Care Act.

Quick facts

Code
PR-247 (CARC 247)
Status
Active In use since September 30, 2012.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The usual framing for a deductible: the patient, or their supplemental coverage, owes the amount.
  • CO (Contractual Obligation): If a remittance shows it under CO, confirm with the payer before billing the patient, because CO amounts are generally not patient-billable.
Official description
Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-247 means

CARC 247 is the deductible for a professional service rendered in an institutional setting and billed on an institutional claim. X12’s note limits it to Medicare bundled payment use under the Patient Protection and Affordable Care Act.

In some Medicare bundled payment models, the institution bills for an episode that includes professional services, which would normally be billed by the physician on a separate professional claim. Medicare still needs to apply beneficiary cost sharing correctly: the Part B deductible for the professional portion is different from the facility’s Part A deductible. CARC 247 lets the remittance show the professional deductible separately, and its companion PR-248 does the same for coinsurance.

Because it is a deductible, it is usually a patient liability, even though this page’s code display uses the CO prefix. Rely on the group code shown on your remittance.

When it appears

  • Institutional claims submitted under a Medicare bundled payment arrangement that includes professional services.
  • Episodes where the beneficiary has not met the Part B deductible for the year.
  • Secondary billing to Medigap or Medicaid, which needs to see the professional deductible separately.
  • Year-start episodes, when beneficiaries are more likely not to have met the annual deductible yet.

How to handle it

  1. Check the group code. With PR, the amount is the beneficiary’s responsibility (or their supplemental payer’s).
  2. Bill any secondary payer first, reporting CARC 247 in the COB data so it recognizes the professional deductible.
  3. Bill the patient for what remains after secondary payment, following Medicare rules and any dual-eligible protections.
  4. If it appears under CO, ask the payer to confirm the liability before billing anyone.
  5. Reconcile the amount against the beneficiary’s deductible status for the year.

How to prevent problems

  • Map CARC 247 to its own posting rule, separate from CARC 1, so professional and facility deductibles are tracked apart.
  • Make sure crossover and secondary claims carry the professional deductible correctly.
  • Check dual-eligible status before sending patient statements, since cost-sharing protections may apply.
  • Review bundled payment remittances with staff familiar with the model’s rules. Eligibility and COB denials covers secondary billing basics.

Remark codes that may appear with PR-247

  • N568 (Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.): The payment relates to a bundled payment model initiative.
  • PR-248 (Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.): The coinsurance counterpart for the same bundled institutional billing.
  • PR-1 (Deductible Amount): The standard deductible code used for ordinary claims.
  • PR-66 (Blood Deductible.): The Medicare blood deductible, another specialized deductible code.

PR-247 FAQ

Why not just use CARC 1 for the deductible?

CARC 247 separates the professional deductible that is billed on an institutional bundled claim from the facility deductible. That distinction matters for Medicare bundled payment models where professional services roll into the institution's claim.

Can I bill the patient for PR-247?

Deductibles are normally patient responsibility, and the payer usually reports it with PR. If it appears with CO, ask the payer to clarify before billing.

Will physician offices see PR-247?

Rarely. It is for institutional claims under Medicare bundled payment arrangements, so it mainly appears on hospital or facility remittances.

Is PR-247 the Part A or Part B deductible?

It is the deductible for the professional service, which falls under Part B, even though it appears on an institutional claim. The facility's inpatient deductible is reported separately.