PR 3 denial code

Claim adjustment reason code 3. Often reported as PR 3.

Copayment amount

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 3 means

A fixed copay set by the patient's plan was taken out of the payment and left for the patient to pay.

A copay is a flat amount the plan expects the patient to pay for certain visits or services, regardless of the allowed amount. The payer reduced its payment by that amount and reported it with this code.

Group code PR is the norm here. Many offices collect the copay at check in, so the main task is matching what was collected against what the payer applied.

Group codes seen with 3

On a remittance, 3 comes after a group code. These are the ones it is most often reported with:

• PR 3 (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 plan applies a flat copay to office visits, specialist visits, urgent care or similar services.
• The service was processed under a different copay tier than the front desk expected, such as specialist instead of primary care.
• More than one copay was applied because the payer treated services as separate visits.

What to do next

1. Match the copay on the remittance with the amount collected at the time of service.
2. Refund or credit the patient if the office collected more than the copay the payer applied.
3. Ask the payer to review the claim if a copay was applied to a service the plan says should have none.
4. Bill any secondary coverage that may pick up the copay before billing the patient.

Related codes

• 1 (reason code) Amount applied to the deductible
• 2 (reason code) Patient's coinsurance share
• 45 (reason code) Charge exceeds the allowed amount