PR 27 denial code

Claim adjustment reason code 27. Often reported as PR 27 or CO 27.

Service after coverage ended

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 27 means

The service was provided after the patient's coverage with this payer ended, so the plan did not pay for it.

The payer's records show the patient's coverage ended before the date of service. This often happens after a job change, a missed premium, aging out of a parent's plan or a move between plans at the start of a year.

With group code PR the payer treats the charge as the patient's responsibility. With CO it is assigning the loss to the provider, often because of the contract or a missed eligibility check. Either way, look for other coverage first.

Group codes seen with 27

On a remittance, 27 comes after a group code. These are the ones it is most often reported with:

• PR 27 (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 27 (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

• The patient's coverage was terminated and they did not update the practice.
• The patient switched plans and the claim went to the old plan.
• The coverage ended for non-payment of premium, sometimes after a grace period.
• Eligibility was verified at the first visit but not rechecked on later dates of service.

What to do next

1. Check eligibility for the exact date of service and ask the patient about any new coverage.
2. Bill the plan that was active on the date of service, within its filing limits.
3. If coverage was ended in error, have the patient ask the plan to reinstate it and then request reprocessing.
4. Confirm the group code before moving any balance to the patient.
5. Recheck eligibility at every visit to prevent repeat denials.

Related codes

• 26 (reason code) Service before coverage began
• 22 (reason code) Another payer may be primary
• 29 (reason code) Timely filing limit has passed