Denial Code Decoder
PR-2 — Applied to coinsurance
The patient owes a percentage of the allowed amount for this service. Coinsurance is the cost share people understand least, because unlike a copay it is not a number they can be told at the desk — it is a share of a figure nobody knows until the payer adjudicates. It also sits between the other two: the deductible comes first, coinsurance applies after it is satisfied.
Billable to the patient? Yes — this is patient responsibility, calculated on the allowed amount and never on 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 assigned amount match the plan's coinsurance rate applied to the allowed amount?
Take the allowed amount from this line, not the charge, and apply the plan's percentage. A mismatch usually means the wrong allowed amount, not the wrong percentage.
The full decision tree
Does the assigned amount match the plan's coinsurance rate applied to the allowed amount?
Take the allowed amount from this line, not the charge, and apply the plan's percentage. A mismatch usually means the wrong allowed amount, not the wrong percentage.
- Yes →
Is there secondary coverage?
- Yes →
Bill the secondary first. Submit to the secondary with the primary remittance attached; many plans pick up coinsurance in whole or in part. Only what survives that goes to the patient.
- No →
Bill the patient their share. Move the balance to patient responsibility with a statement that shows the allowed amount and the share applied — a coinsurance line that shows its arithmetic is disputed far less often than one that shows only a total.
- Yes →
- No →
Reconcile before billing the patient. Check whether the allowed amount matches your contracted rate. An out-of-network or stale allowed amount inflates the patient's share, and the patient is the last person who can catch it.
Prevention
Estimate before the visit rather than after, and explain it as a share rather than a figure. A patient who was told to expect a percentage of an allowed amount is far less likely to dispute the statement than one who was quoted a number that turned out to be wrong.
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 2. 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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