Denial code PR-2: Coinsurance amount
The plan paid its share of the allowed amount and this is the patient’s percentage share — a normal covered-claim outcome, not a denial.
Coinsurance amount.
What PR-2 actually means
PR-2 reports the percentage of the allowed amount that the benefit plan assigns to the patient after the deductible has been met — commonly 20% under traditional Medicare Part B, and anywhere from 10% to 50% commercially. The payer has paid its portion; the coinsurance figure is a collectible patient balance, not a contractual adjustment, and writing it off routinely can create compliance exposure.
Why this denial happens
- Standard plan design — the patient owes a fixed percentage of every allowed amount.
- Out-of-network benefit tier applies a higher coinsurance percentage than expected.
- The service fell into a benefit category with its own coinsurance rate.
How to resolve a PR-2 denial
- Post as patient responsibility, not as a contractual adjustment.
- If secondary or supplemental coverage exists, bill it with the primary remittance attached — many supplements exist specifically to cover coinsurance.
- Statement the patient once secondary adjudication is complete.
How to prevent it
- Quote patients an estimated out-of-pocket figure at scheduling using the plan’s coinsurance percentage.
- Capture secondary coverage at registration so coinsurance can be crossed over automatically.
Frequently asked
What does denial code PR-2 mean?
The plan paid its share of the allowed amount and this is the patient’s percentage share — a normal covered-claim outcome, not a denial. The X12 description reads: "Coinsurance amount."
How do I fix a PR-2 denial?
Post as patient responsibility, not as a contractual adjustment. If secondary or supplemental coverage exists, bill it with the primary remittance attached — many supplements exist specifically to cover coinsurance. Statement the patient once secondary adjudication is complete.
Can PR-2 be billed to the patient?
This code normally moves the balance to patient responsibility, subject to your payer agreement and to any advance notice of non-coverage requirements that apply.
Related denial codes
See how much PR-2 is costing you
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General revenue-cycle guidance, not legal, coding, or payer-specific advice. Claim adjustment reason codes are maintained by X12 and are revised periodically; payer policy and your provider agreement govern in any specific case. Always read the remark codes transmitted with the denial — they frequently carry the detail this code does not.