PR 1 denial code

Claim adjustment reason code 1. Often reported as PR 1.

Amount applied to the deductible

Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated Nov 11, 2026.

What 1 means

Part or all of the allowed amount went toward the patient's deductible, so the payer did not pay that portion.

The payer accepted the service and priced it, but the patient has not yet satisfied the deductible for the benefit period. The amount reported with this code was counted toward that deductible instead of being paid.

It almost always comes with group code PR, meaning the plan treats it as the patient's share. Early in a plan year it is very common and often covers the whole allowed amount.

Group codes seen with 1

On a remittance, 1 comes after a group code. These are the ones it is most often reported with:

• PR 1 (Patient Responsibility): The amount is assigned to the patient. Deductibles, coinsurance and copays are the everyday examples. Whether you can collect it still depends on your contract and the patient's plan.

The payer chooses the group code for each adjustment, so the same reason code can appear with another group code on your remittance. Read the two together. More about group codes.

Common causes

• The service fell early in the plan year before the patient met the deductible.
• The patient has a high deductible plan and has not reached the threshold yet.
• The service falls under a separate deductible, such as an out-of-network or specialty deductible.

What to do next

1. Confirm the deductible amount on the remittance matches the allowed amount and the patient's benefits.
2. Transfer the deductible portion to patient responsibility if the group code is PR and your policy allows it.
3. Check whether a secondary plan should be billed for the deductible before sending a patient statement.
4. If the patient says the deductible was already met, check the payer portal and ask for reprocessing if needed.

Related codes

• 2 (reason code) Patient's coinsurance share
• 3 (reason code) Copayment amount
• 45 (reason code) Charge exceeds the allowed amount