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PR-3 Denial Code: Co-payment Amount

PR-3 means the adjustment is the patient's co-payment: a flat dollar amount their plan requires for this type of visit or service. It is patient responsibility, so collect it from the patient, ideally at check-in, rather than from the payer.

Quick facts

Code
PR-3 (CARC 3)
Status
Active In use since January 1, 1995.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The standard use. The co-payment is owed by the patient and may be collected at the time of service.
  • CO (Contractual Obligation): Unusual. A co-payment reported under CO means the provider absorbs it, for example when a contract or program waives patient cost-sharing. Confirm before writing it off.
Official description
Co-payment Amount
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-3 means

CARC 3 is the co-payment amount: a set dollar figure the patient’s plan charges for a type of service, such as an office visit, specialist visit, therapy session, or urgent care visit. With the PR group code, it tells you the payer subtracted this amount from its payment because the patient owes it.

Unlike a deductible or coinsurance, a co-payment is usually predictable. If the eligibility response says the plan has a $40 specialist copay, you should expect to see PR-3 for $40 on the line, with the payer paying the rest of the allowed amount. When the allowed amount is lower than the copay, PR-3 may equal the whole allowed amount and the payer pays nothing.

Common causes of PR-3 surprises

  • Wrong visit tier. The payer applied a specialist copay to what you expected as a primary care visit, or the reverse, often because of provider taxonomy or network setup.
  • Multiple copays on one date. Some plans apply a copay per visit, per provider, or per service type, so a patient seen for two services on one day may owe more than one.
  • Copay versus coinsurance confusion. Some plans switch to coinsurance for certain services, so the patient owes PR-2 instead of a copay.
  • Plan change. The patient changed plans and the copay collected at the desk was based on the old card.
  • Telehealth or behavioral health benefits that carry a different copay than in-person medical visits, depending on the plan.

How to handle it

  1. Match PR-3 to what you collected at check-in. Apply the payment and resolve any difference.
  2. Refund overpayments promptly when the collected copay is higher than PR-3.
  3. Bill secondary coverage if the patient has any, since some secondary plans pay primary co-payments.
  4. Bill the patient for any remaining PR-3 balance.
  5. Challenge a wrong tier. If the payer applied the wrong copay because of how your provider is set up, fix the enrollment record and ask the payer to reprocess affected claims. See provider enrollment denials.

How to prevent copay problems

  • Verify the copay for the specific service type during the eligibility check, not just the plan’s general office copay.
  • Scan the insurance card at every visit to catch plan changes before the claim is filed. See eligibility and COB denials.
  • Collect at check-in and record the amount so posting staff can reconcile it to PR-3 quickly.
  • Keep copays out of denial metrics. PR-3 is expected patient revenue, not a denial.

Specialty notes

Behavioral health and PT/OT practices often see copays on every session. Patients with many visits can build up balances quickly, so a clear, consistent collection process matters more for these specialties than for occasional-visit practices.

Remark codes that may appear with PR-3

  • N130 (Consult plan benefit documents/guidelines for information about restrictions for this service.): Refers you to the plan documents for how co-payments apply to this service type.
  • PR-1 (Deductible Amount): Deductible, the amount the patient pays before plan benefits apply.
  • PR-2 (Coinsurance Amount): Coinsurance, a percentage of the allowed amount rather than a set dollar figure.
  • CO-241 (Low Income Subsidy (LIS)): Low Income Subsidy co-payment amount, a specific co-payment type for subsidized Medicare beneficiaries.
  • CO-100 (Payment made to patient/insured/responsible party.): Payment made to the patient instead of the provider, another reason you may need to collect from the patient.

PR-3 FAQ

What is the difference between PR-3 and PR-2?

PR-3 is a fixed dollar co-payment, such as $30 per visit. PR-2 is coinsurance, a percentage of the allowed amount. Some plans use both for different services.

Should I collect the co-payment before the claim is paid?

Usually yes. Co-payments are known in advance from the eligibility check, so most practices collect them at check-in. The ERA then confirms the amount with PR-3.

The patient paid a copay at the visit but PR-3 is different. What now?

Compare the PR-3 amount to what you collected. If you collected more, refund the difference; if less, bill the balance. Differences often come from a specialist copay being applied instead of a primary care copay, or the reverse.

Can I waive a patient's co-payment?

Routinely waiving co-payments can conflict with payer contracts and, for government programs, with federal rules. Follow your payer agreements and compliance guidance, and document any financial hardship exceptions.