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PR-248 Code: Coinsurance on Institutional Bundled Claim

PR-248 reports the coinsurance 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-248 (CARC 248)
Status
Active In use since September 30, 2012.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The normal treatment for coinsurance: the beneficiary or their supplemental coverage owes the amount.
  • CO (Contractual Obligation): If shown under CO, the payer is not assigning it to the patient; clarify with the payer before billing.
Official description
Coinsurance 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-248 means

CARC 248 is the coinsurance for a professional service rendered in an institutional setting and billed on an institutional claim. Like its sibling PR-247, X12 limits it to Medicare bundled payment use under the Affordable Care Act.

Under certain Medicare bundled payment models, a facility’s claim can include professional services. Medicare applies Part B coinsurance to the professional portion, which is calculated differently from facility cost sharing. CARC 248 isolates that professional coinsurance on the facility’s remittance so it can be passed correctly to secondary payers and patients.

Example: an institutional claim for a bundled episode includes a professional component. After the payer calculates its payment for that component, the beneficiary’s share of the professional part is reported as CARC 248, separate from any facility coinsurance.

When it appears

  • Facility claims under a Medicare bundled payment arrangement that roll professional services into the institutional bill.
  • Beneficiaries with Part B coinsurance owed on the professional portion.
  • Crossover claims to Medigap or Medicaid that need the professional coinsurance identified.
  • Mixed episodes where both facility and professional cost sharing apply, so the remittance shows more than one coinsurance line and each must be posted to the right bucket.

Physician practices billing on their own professional claims will not see this code; their coinsurance appears as ordinary CARC 2.

How to handle it

  1. Read the group code. Under PR, the amount goes to the secondary payer or the patient.
  2. Send it to the secondary payer with the professional coinsurance identified in the COB loop.
  3. Bill the patient only for the balance remaining after the secondary payer, and only where Medicare and Medicaid rules allow.
  4. Question CO usage. If the payer reported it under CO, confirm the liability before billing anyone.
  5. Reconcile professional and facility coinsurance separately in posting.

How to prevent problems

  • Configure posting so CARC 248 is not merged with standard coinsurance (CARC 2).
  • Test crossover output to make sure professional coinsurance reaches secondary payers.
  • Verify qualified Medicare beneficiary and other dual-eligible statuses before patient billing.
  • Train facility billing teams on how bundled payment models change cost-sharing reporting.
  • Review remittances with an ERA Analyzer to catch professional coinsurance that was never forwarded.

Remark codes that may appear with PR-248

  • 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-247 (Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.): The deductible counterpart for professional services on an institutional bundled claim.
  • PR-2 (Coinsurance Amount): The standard coinsurance code for ordinary claims.
  • PR-3 (Co-payment Amount): A fixed co-payment, rather than a percentage-based coinsurance.

PR-248 FAQ

What is the difference between PR-248 and PR-2?

CARC 2 is general coinsurance. CARC 248 identifies coinsurance on the professional portion of a Medicare bundled institutional claim, so secondary payers and the facility can tell it apart from facility coinsurance.

Who pays PR-248 coinsurance?

Usually the beneficiary or a supplemental payer such as Medigap or Medicaid, when the payer reports it with PR. Check the group code on the remittance.

Does PR-248 appear on professional claims?

No. It is designed for institutional claims that include professional services under a Medicare bundled payment model.

Does a Medigap plan pay PR-248 coinsurance?

Many Medigap plans cover Part B coinsurance, so the amount often crosses over to the supplemental plan. Coverage depends on the specific Medigap plan the beneficiary has.