Denial Code Decoder
PR-1 — Applied to the deductible
The allowed amount was applied to the patient's deductible — the plan's annual amount the patient pays before benefits begin. This is not a denial of the service; it is the payer saying the patient owes this portion.
Billable to the patient? Yes — this IS patient responsibility, at the allowed amount (never the billed charge).
Where this denial is born
- Front desk
- Coding
- Claim build
- Submission
- Adjudication
This denial is usually created at the highlighted stage — that is where prevention lives.
Answer the questions — follow the path
The same questions an experienced biller asks, in order. Your answers draw the route to the right action.
Does the applied amount match the payer's allowed amount?
The patient owes the ALLOWED amount, not the billed charge.
The full decision tree
Does the applied amount match the payer's allowed amount?
The patient owes the ALLOWED amount, not the billed charge.
- Yes →
Is there secondary coverage that picks up the deductible?
- Yes →
Bill the secondary first. Submit to the secondary with the primary remittance — many secondaries cover deductible amounts in full or part.
- No →
Bill the patient the allowed amount. Move the balance to patient responsibility and send a clear statement showing the insurance processed the claim and applied it to the deductible.
- Yes →
- No →
Verify before billing the patient. A mismatch usually means a posting error or an out-of-network allowed amount — reconcile before a wrong balance reaches a statement.
Prevention
Check remaining deductible in the eligibility response and collect an estimate at time of service — a deductible balance collected at the desk costs a fraction of one chased by statement.
Related reading
The code list, and when it was last checked
X12 maintains the Claim Adjustment Reason Codes list, where this code is listed as 1. The list carries the number alone: the PR in front of it is the adjustment group the payer chose for this line, which decides who owes the balance, and the same code can arrive under a different group from a different payer. It has been on the list since January 1, 1995.
Checked against the list revision dated November 1, 2025 on August 7, 2026, where it reads as an active code.
Sources
The paragraphs behind the guidance above. A page that tells you what to do about money should show you what the instruction rests on.
- CMS — Glossary of Health Coverage and Medical Terms (the uniform glossary; OMB 0938-1146): Allowed Amount, Coinsurance and Copayment at p. 1, Deductible and Excluded Services at p. 2, and the worked cost-sharing example at p. 6 (opens in a new tab)
- 42 CFR 424.55(b) — in accepting assignment a supplier agrees to take the approved amount as the full charge for the service, and to collect from the beneficiary only the difference between that approved amount and the program payment (opens in a new tab)
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