PR 238 denial code

Claim adjustment reason code 238. Often reported as PR 238.

Ineligible period reduction (patient)

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 238 means

Part of the claim fell in a period when the patient was not covered, and this reduction is for that uncovered part.

The service dates straddle the start or end of the patient's coverage. The payer paid the covered dates and adjusted the rest with this code.

It is used only with group code PR, so the payer is telling you the uncovered part is the patient's responsibility unless another plan covered those dates.

Group codes seen with 238

On a remittance, 238 comes after a group code. These are the ones it is most often reported with:

• PR 238 (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

• An inpatient stay began before or ended after the patient's coverage.
• A span of services crossed the date the patient's plan changed.
• Coverage started or ended mid-month during a recurring service.

What to do next

1. Check the exact coverage start and end dates with the payer.
2. Bill any plan that covered the uncovered dates.
3. Confirm the split is correct before following your patient balance process.

Related codes

• 239 (reason code) Claim spans covered and uncovered dates
• 200 (reason code) Service during a gap in coverage
• 27 (reason code) Service after coverage ended