PR 202 denial code
Claim adjustment reason code 202. Often reported as PR 202 or CO 202.
Personal comfort or convenience item
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 .
What 202 means
The item or service is treated as a personal comfort or convenience, which the plan does not cover.
Plans generally pay for care that treats a medical condition, not for items that mainly make a stay or visit more comfortable or convenient.
Think television or phone charges, guest meals, toiletries or a private room by patient choice. Whether the patient can be billed often depends on notices given in advance and the group code.
Group codes seen with 202
On a remittance, 202 comes after a group code. These are the ones it is most often reported with:
- PR 202 (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 202 (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
- A hospital bill included in-room amenities such as television, phone or guest trays.
- A private room was billed without documentation that it was medically necessary.
- Convenience supplies were billed as if they were medical supplies.
What to do next
- Check whether the charge should have been billed as non-covered from the start.
- If a medical need existed, such as isolation for a private room, appeal with the documentation.
- Confirm whether a signed notice or patient agreement allows billing the patient before doing so.
- Review chargemaster flags so convenience items go on the claim as non-covered.
Related codes
- 204 (reason code) Not covered under the patient's plan
- 96 (reason code) Service not covered by the plan
- 50 (reason code) Not medically necessary per the payer
Source
Official wording: X12 Claim Adjustment Reason Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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