PR 241 denial code

Claim adjustment reason code 241. Often reported as PR 241.

Low income subsidy copay

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 241 means

The amount is the copayment for a patient who gets the low income subsidy, which sets lower cost sharing.

Patients who qualify for the low income subsidy, mostly in Medicare drug coverage, have reduced copays. This code labels the copay at that subsidized level.

It explains the patient share and is not a denial. If the amount looks wrong, the patient's subsidy status on file with the plan is the first thing to check.

Group codes seen with 241

On a remittance, 241 comes after a group code. These are the ones it is most often reported with:

• PR 241 (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 is enrolled in a low income subsidy program.
• A prescription was filled and the subsidized copay applied.
• The patient's subsidy level changed and the copay amount changed with it.

What to do next

1. Collect only the subsidized copay amount shown on the remittance.
2. Update the patient's subsidy status in your system if it changed.
3. Contact the plan if the copay does not match the patient's subsidy level.

Related codes

• 3 (reason code) Copayment amount
• 2 (reason code) Patient's coinsurance share