PR-2 Denial Code: Coinsurance Amount
PR-2 is a claim adjustment reason code meaning coinsurance amount: the percentage of the allowed amount the patient owes after the deductible, assigned to patient responsibility by the PR group code. It is not a denial. Under Medicare Part B the standard coinsurance is 20 percent of the allowed amount.
- Group
- PR (Patient Responsibility)
- Category
- Cost sharing / coinsurance
- Appealable?
- No; it is correct adjudication, bill the patient or secondary
- Typical fix
- Bill secondary insurance if any, then statement the patient
What does PR-2 mean on a remittance?
PR-2 is the code for "coinsurance amount": the percentage share of the allowed amount that the patient's plan design makes the patient pay. The PR group code is doing the important work here; it says this money is patient responsibility, legitimately billable to the patient or to a secondary payer, unlike CO amounts, which the practice absorbs.
Standard Medicare Part B example: you bill 99214 at $180.00. Medicare allows $128.00, the deductible is already met, so Medicare pays 80 percent ($102.40) and the ERA shows PR-2 $25.60, the patient's 20 percent coinsurance. Billed $180.00, allowed $128.00, paid $102.40, CO-45 $52.00 (over-allowed write-off), PR-2 $25.60. Every dollar is accounted for.
Why does PR-2 appear on a claim?
Because the plan has percentage-based cost sharing and the claim adjudicated normally. You will see PR-2 on virtually every paid Medicare Part B claim without a Medigap crossover, and on commercial claims for services subject to coinsurance rather than flat copays, most often after the deductible is met. Volume of PR-2 is not a problem to solve; it is arithmetic. The problems worth investigating are PR-2 amounts that look wrong: coinsurance calculated on the billed amount instead of the allowed amount, or cost sharing applied to a service that should be covered at 100 percent, like many preventive services under ACA rules.
How do you handle PR-2 amounts correctly?
- Post the PR-2 dollars to patient responsibility, never to adjustments.
- Check for secondary coverage first. Medigap and many secondaries exist precisely to pay Medicare coinsurance; bill them before the patient, with the primary remittance data attached.
- If no secondary, statement the patient promptly. Collection likelihood decays fast; a balance billed within a week of the ERA is far more collectible than one billed at 60 days.
- Spot-check the math on high-dollar claims: PR-2 should be the plan's percentage of the allowed amount, nothing else.
How do you reduce PR-2 surprises and write-offs?
Estimate coinsurance before service for scheduled procedures using the payer's allowed amounts, and collect at check-in or set up a payment plan on the spot; point-of-service collection is several times more effective than statements. Verify secondary coverage during registration so coinsurance flows automatically via crossover instead of aging on the patient ledger. Give front-desk staff a one-line script: "your plan pays 80 percent of the allowed amount, and today's estimated 20 percent is X." Patients pay predictable numbers.
Can you appeal PR-2?
Not as such; coinsurance is correct adjudication, not an adverse decision. What you can dispute is miscalculation or misclassification: coinsurance taken on a zero-cost-share preventive service, percentage applied to billed rather than allowed charges, or cost sharing applied when a secondary should have covered it. For those, submit a corrected claim or a payment dispute with the plan documents, using the denial code lookup to verify what the accompanying codes say and the appeal letter generator if the payer will not correct a clear cost-sharing error.
Frequently asked questions
No. PR-2 is the remittance code that assigns the coinsurance portion of the allowed amount to the patient. The claim processed and often paid; the PR-2 dollars are simply the patient's contractual share. The correct response is billing the secondary payer or the patient, not reworking the claim.
Coinsurance is a percentage of the allowed amount, so it varies with the service price; a copay (reported as PR-3) is a flat dollar amount per visit. A patient can owe both on the same claim depending on plan design. Medicare Part B coinsurance is typically 20 percent of the allowed amount.
No. Routine waiver of Medicare coinsurance can violate the Anti-Kickback Statute and false claims rules, and most commercial contracts prohibit it too. Waivers must be case-by-case, based on documented financial hardship, under a written policy. Collect coinsurance consistently or discount through a compliant hardship program.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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