PR 201 denial code

Claim adjustment reason code 201. Often reported as PR 201.

Patient owes under a set-aside agreement

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 201 means

The patient is responsible for this amount because of a set-aside arrangement or similar agreement that sets money aside for future care.

This mostly appears where a settlement left funds set aside to pay for future medical care related to an injury. The payer is saying those funds, not the plan, should pay.

It is used only with group code PR and always comes with at least one remark code that explains the arrangement. Workers' compensation payers use a different code for the same idea.

Group codes seen with 201

On a remittance, 201 comes after a group code. These are the ones it is most often reported with:

• PR 201 (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 received an injury settlement that included a set-aside account for future care.
• The service relates to a condition covered by a settlement or other agreement.
• The payer's records link the patient to an arrangement that makes the patient liable first.

What to do next

1. Read the remark codes on the line to understand which agreement the payer is pointing to.
2. Ask the patient or their representative for set-aside account details and billing instructions.
3. Bill the set-aside administrator or the patient as the agreement directs, after confirming the remittance.

Related codes

• 215 (reason code) Subrogation from a third-party settlement
• 22 (reason code) Another payer may be primary
• 23 (reason code) Prior payer payment affected this claim