PR 160 denial code

Claim adjustment reason code 160. Often reported as PR 160 or CO 160.

Injury from an excluded activity

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 160 means

The injury or illness came from an activity the plan does not cover, so the related service is excluded.

Some plans exclude care for injuries from certain activities, for example dangerous hobbies or illegal acts. This code means the payer linked your service to one of those excluded activities.

The decision often rests on the accident details on the claim or a patient questionnaire. If those details are wrong, correcting them can change the outcome.

Group codes seen with 160

On a remittance, 160 comes after a group code. These are the ones it is most often reported with:

• PR 160 (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.
• CO 160 (Contractual Obligation): The provider's side of the ledger. The reduction comes from the payer contract or a rule the provider has to follow, and the patient normally cannot be billed for it.

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 patient was injured in an activity the plan lists as excluded.
• The claim's injury details or the patient's accident questionnaire pointed to the exclusion.
• The payer matched the diagnosis or cause code to an excluded activity.

What to do next

1. Check the accident and cause details on the claim against the record.
2. Ask the payer which exclusion it applied and review the plan document.
3. Appeal or correct the claim if the activity was not actually excluded.

Related codes

• 157 (reason code) Service resulted from an act of war
• 204 (reason code) Not covered under the patient's plan