PR 248 denial code

Claim adjustment reason code 248. Often reported as PR 248.

Facility-billed professional coinsurance

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 248 means

This is the coinsurance on a professional service that was given in an institutional setting and billed on the facility claim.

Like code 247, this belongs to arrangements where the professional part of the care is billed on the facility claim. It shows the patient's coinsurance share for the professional part of the bundled claim.

It is cost sharing, not a denial. Secondary or supplemental coverage often picks it up, so send the claim on before treating it as a patient balance.

Group codes seen with 248

On a remittance, 248 comes after a group code. These are the ones it is most often reported with:

• PR 248 (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 professional service carried coinsurance under the patient's benefit.
• The facility billed professional services on its institutional claim under a bundled model.
• No secondary coverage was on file at the time of processing.

What to do next

1. Check that the coinsurance amount is consistent with the allowed amount.
2. Send the claim on to any secondary or supplemental payer.
3. Follow your patient balance process for what remains after secondary payment.

Related codes

• 247 (reason code) Facility-billed professional deductible
• 2 (reason code) Patient's coinsurance share
• 1 (reason code) Amount applied to the deductible