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PR-85 Denial Code: Patient Interest Adjustment

PR-85 is a patient interest adjustment. It reports interest that is the patient's responsibility, and X12 says CARC 85 may only be used with group code PR.

Quick facts

Code
PR-85 (CARC 85)
Status
Active In use since January 1, 1995; last modified July 9, 2007.
Code set
Claim Adjustment Reason Codes (CARC)
Group codes
  • PR (Patient Responsibility): The only group X12 allows for this code. The interest amount is the patient's (or responsible party's) responsibility, not the payer's or the provider's.
Official description
Patient Interest Adjustment (Use Only Group code PR)
X12 Claim Adjustment Reason Codes, retrieved September 25, 2026
Last verified
against the official X12 list.

What PR-85 means

CARC 85 is the patient interest adjustment. It tells you that part of the amount on the remittance represents interest owed by the patient, insured, or responsible party. The X12 committee restricts it to group code PR, and adds a note: use it only when paying interest is the patient’s responsibility.

On an ERA (835) or paper EOB you should therefore see it as PR-85. That matters for posting: PR amounts move to the patient balance, while CO amounts are written off by the provider.

You will rarely see this code. It turns up mostly in arrangements where a payer or plan administers a patient payment plan or tracks interest on a patient balance, rather than on routine office claims.

Common causes

  • A patient balance was placed on a payment plan that carries interest, and the payer or administrator reports the interest portion separately.
  • A plan or program applies a finance charge to a late patient share and passes it through on the remittance.
  • A payer mistakenly uses CARC 85 for its own prompt-pay interest. Payer-paid prompt-pay interest is normally reported in the claim interest fields or at the provider level of the 835, not as a patient adjustment.
  • A CO group was attached to CARC 85 by error in the payer’s adjudication system.

How to fix it

  1. Check the group code first. PR-85 is consistent with the official definition. CO-85 is not, so do not write the amount off until you know what the payer intended.
  2. Confirm the source of the interest. Ask the payer what balance and period the interest covers and whether it relates to a payment arrangement with the patient.
  3. Post PR-85 to patient responsibility only if the amount agrees with the terms the patient accepted and with your own financial policy.
  4. Check local rules before billing interest. State consumer-credit and medical-debt rules can limit finance charges on patient balances. When in doubt, ask your compliance advisor.
  5. Request a corrected remittance if the group code is wrong or the payer used CARC 85 for its own interest payment. A corrected claim is not needed because nothing on your claim caused the adjustment.

How to prevent problems with PR-85

  • Map CARC 85 in your practice management system to a patient interest transaction type, not to a contractual write-off, so it never disappears from the patient ledger silently.
  • Flag any remittance where CARC 85 arrives with a group other than PR for manual review.
  • Keep written payment plan terms on file for every patient whose balance can accrue interest.
  • Review informational adjustments separately from denials. Mixing them inflates denial counts and hides real problems. See how to read CARC and RARC codes for a triage approach.
  • CO-225 (Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)): Penalty or interest paid by a payer, limited to plan-to-plan encounter reporting in the 837, not patient interest.
  • PR-1 / PR-2 / PR-3 (Deductible, coinsurance, and co-payment amounts.): Ordinary patient cost-sharing. Interest under CARC 85 is separate from these amounts.
  • OA-209 (Per regulatory or other agreement.): Used when regulation or agreement says the provider cannot collect an amount from the patient.
  • OA-23 (The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)): Reports the impact of a prior payer's adjudication, which is a different kind of informational adjustment.

PR-85 FAQ

Which group code does CARC 85 use?

Only PR. The official X12 usage note limits CARC 85 to group code PR, because the interest is owed by the patient or responsible party.

Can I bill the patient for a PR-85 amount?

The PR group means the payer considers the amount patient responsibility. Before billing, confirm the interest amount matches your payment agreement with the patient and any state rules on finance charges.

Is CARC 85 a denial?

No. It is an informational adjustment that separates patient-owed interest from the rest of the claim. The service itself is not being denied.

What should I do if CARC 85 appears with a CO group?

Contact the payer and ask for a corrected remittance. Under CO, the amount would be a provider write-off, which conflicts with the code's official usage.