PR 275 denial code

Claim adjustment reason code 275. Often reported as PR 275.

Prior payer's patient share not covered

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 275 means

This payer will not pick up the deductible, coinsurance, or copay left by the primary payer, so that amount stays with the patient.

You see this on a secondary or later claim. The primary payer assigned some of the claim to the patient, and the plan you billed next is saying it does not cover that cost sharing, for example because its benefit design does not include it.

It is only used with group code PR, so the payer is telling you the patient remains responsible. Still confirm against the contracts and any Medicaid or dual eligibility rules that bar billing the patient.

Group codes seen with 275

On a remittance, 275 comes after a group code. These are the ones it is most often reported with:

• PR 275 (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 secondary plan does not cover the primary payer's deductible, coinsurance, or copay.
• The secondary plan's own cost sharing or coordination method leaves nothing payable.
• The patient's secondary coverage is limited and does not include cost sharing pickup.

What to do next

1. Compare the primary remittance with the secondary one to confirm the amount carried to the patient.
2. Check whether the patient has Medicaid or another program that limits what you may collect.
3. Look for another payer that may cover the remaining amount before billing the patient.
4. Bill the patient for the amount only if your contracts and the remittance support it, and include both remittances if asked.

Related codes

• 276 (reason code) Prior payer denied, so not covered here
• 303 (reason code) QMB: prior payer cost sharing not covered
• 1 (reason code) Amount applied to the deductible
• 2 (reason code) Patient's coinsurance share