PR 2 denial code

Claim adjustment reason code 2. Often reported as PR 2.

Patient's coinsurance share

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 2 means

This is the patient's percentage share of the allowed amount under their plan, so the payer left it unpaid.

After the deductible is satisfied, many plans split the allowed amount by percentage, for example the plan pays most of it and the patient pays the rest. The amount reported here is that patient percentage.

It is normally reported with group code PR. The figure should line up with the allowed amount and the coinsurance rate in the patient's benefits.

Group codes seen with 2

On a remittance, 2 comes after a group code. These are the ones it is most often reported with:

• PR 2 (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 patient's plan has a coinsurance percentage for this type of service.
• The service was processed at an out-of-network coinsurance rate that is higher than the in-network rate.
• The deductible was met, so cost sharing shifted from deductible to coinsurance.

What to do next

1. Check that the coinsurance amount equals the plan's percentage of the allowed amount.
2. Bill any secondary or supplemental coverage before moving the balance to the patient.
3. Move the amount to patient responsibility when the group code is PR and the math checks out.
4. If the coinsurance rate looks wrong, verify the network status the payer applied to the claim.

Related codes

• 1 (reason code) Amount applied to the deductible
• 3 (reason code) Copayment amount
• 45 (reason code) Charge exceeds the allowed amount