CO P22 denial code

Claim adjustment reason code P22. Often reported as CO P22 or PR P22.

Adjusted under auto PIP or MPC rules

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 P22 means

The auto insurer reduced payment under personal injury protection (PIP) or medical payments coverage (MPC) rules or policy.

It is limited to auto insurance medical claims. Unlike P21, the claim was paid, but less than billed, because of a PIP or medical payments rule or policy term.

The remittance may name the policy or rule. Fee schedule reductions use P23 instead, so P22 points to other policy limits, such as coverage caps or copays.

Group codes seen with P22

On a remittance, P22 comes after a group code. These are the ones it is most often reported with:

• CO P22 (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.
• PR P22 (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 PIP or medical payments limit was reached during the claim.
• Policy terms such as a deductible or copay applied.
• A state auto rule limited the payment for the service.

What to do next

1. Ask the adjuster which policy term or rule caused the reduction.
2. Check the remaining policy limit and other coverage for the balance.
3. Bill the next payer or the patient only as the state's auto rules allow.

Related codes

• P21 (reason code) Denied under auto PIP or MPC rules
• P23 (reason code) Auto PIP or MPC fee schedule adjustment