PR 85 denial code

Claim adjustment reason code 85. Often reported as PR 85.

Interest owed by the patient

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 85 means

Interest charged to the patient, not the payer, was added to or adjusted on the claim.

This code reports interest that is the patient's responsibility under the plan or an arrangement. It does not describe prompt pay interest that the payer owes the provider.

It is meant to be used only with group code PR. If you see it with any other group code, or on a claim where no patient interest applies, ask the payer to correct the remittance.

Group codes seen with 85

On a remittance, 85 comes after a group code. These are the ones it is most often reported with:

• PR 85 (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 payer is relaying interest that the patient owes under the plan's terms.
• The plan or arrangement makes the patient, not the payer, liable for interest on this claim.
• A claim adjustment recalculated interest on a patient balance.

What to do next

1. Confirm the code arrived with group PR, since that is the only group it is meant for.
2. Check whether your patient financial policy and state rules allow interest on the balance.
3. Ask the payer to correct the remittance if the interest appears to be payer interest misreported.

Related codes

• 225 (reason code) Payer penalty or interest