PR 180 denial code

Claim adjustment reason code 180. Often reported as PR 180 or CO 180.

Residency requirements not met

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 180 means

The payer decided the patient did not meet the residency rules for this coverage or benefit.

Some programs, especially state or public plans, cover only people who live in a certain area. This code means the payer did not consider the patient a resident for this coverage.

Check the patient's address on file and on the claim. An outdated address can cause this.

Group codes seen with 180

On a remittance, 180 comes after a group code. These are the ones it is most often reported with:

• PR 180 (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 180 (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 moved out of the plan's service area.
• The address on the claim or on file with the payer was wrong.
• The program requires residency that the patient has not proven.

What to do next

1. Confirm the patient's current address and check it against the payer's record.
2. Ask the patient to update their address or residency with the plan.
3. Check for other coverage that applies where the patient lives.

Related codes

• 177 (reason code) Eligibility requirements not met
• 179 (reason code) Waiting period not met