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PR-36 Denial Code (Deactivated): Balance Under Copay

PR-36 meant the remaining balance was not more than the patient's co-payment, so the payer owed nothing and the amount went to the patient. X12 deactivated it without a named successor; the co-payment itself is reported with CARC 3.

X12 deactivated CARC36 on October 16, 2003. Payers should no longer use it on new remittances, but it can still appear on older ERAs, corrected claims, and appeals.

Code: PR-36 (CARC 36)
Status: Deactivated StoppedOctober 16, 2003 (in use since January 1, 1995).
Code set: Claim Adjustment Reason Codes (CARC)
Group codes: PR (Patient Responsibility): The balance was the patient's co-payment and could be collected from the patient.
Official description: Balance does not exceed co-payment amount.
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified: September 24, 2026 against the official X12 list.

What PR-36 meant

CARC 36 explained a zero-payment line. After the payer applied its allowed amount, what was left was no more than the member’s fixed co-payment. Since the co-payment is the patient’s share, there was nothing left for the plan to pay. The code explained why the check was empty rather than rejecting the service. Because the amount was the member’s share, it normally traveled with the PR group code.

Think of a low-cost service where the allowed amount is below the copay: the patient pays the lower figure and the payer pays nothing.

What replaced it

X12 did not name a successor for code 36. In current practice payers report the patient’s share with PR-3, the co-payment code, and any reduction from billed charges to the allowed amount with CO-45. If a deductible absorbed the balance instead, you would see PR-1.

If you still see PR-36

It can turn up in historical payment data or in an old system that maps legacy codes. Treat it the way you would treat a PR-3 line: the amount is patient responsibility. Post the payer adjustment and transfer the remainder to the patient’s balance.

Before you send a statement, check whether the copay was already collected at the front desk, so the patient is not billed twice for the same amount.

PR-3 (Co-payment Amount): The active code for the co-payment amount the patient owes.
CO-45 (Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.): Often appears alongside co-payment lines to show the reduction to the allowed amount.
PR-1 (Deductible Amount): Deductible amount, the other common reason a small balance goes to the patient.

PR-36 FAQ

Was PR-36 a denial?

Not really. The claim was processed, but the allowed amount was fully absorbed by the co-payment, so the payer's payment was zero and the patient owed the balance.

What code shows this situation today?

Payers simply report the amount as CARC 3, co-payment, with the PR group code. The zero payment is visible from the payment amount itself.

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