PR-1 Denial Code: Deductible Amount
The PR-1 code means the amount was applied to the patient's deductible - the portion of allowed charges the patient must pay each benefit period before the plan starts paying. PR-1 is not a denial and nothing about the claim is wrong: the payer processed it, applied the allowed amount to the deductible, and assigned that amount as patient responsibility.
Common Causes
- The patient has not yet met their annual deductible, so allowed charges pass through to them
- Early-in-the-year claims, when most patients' deductibles reset
- High-deductible health plans, where the deductible absorbs most routine claims
- A secondary payer applying its own deductible after the primary's payment
How to Fix PR-1
- No claim correction is needed - post the allowed amount to patient responsibility and bill the patient
- Bill the patient only the allowed amount shown on the remit, never the full billed charge
- Verify deductible status at eligibility check so patients can be told their likely responsibility up front
- If the patient believes the deductible was already met, have them contact the payer - crossover claims sometimes apply out of order
- Collect deductible estimates at time of service for predictable, high-deductible situations
Frequently Asked Questions
PR-1 means the amount was applied to the patient's deductible. The claim processed normally - the allowed amount became patient responsibility because the deductible for the benefit period has not been met.
No. It is an adjustment assigning the allowed amount to the patient. You bill the patient the deductible amount shown on the remit; there is nothing to correct or appeal on the claim.
Exactly the amount the remit assigns to PR-1 - the payer's allowed amount, not your billed charge. The difference between billed and allowed is written off under the contractual adjustment (typically CO-45).
Related Denial Codes
Related Resources
Claim adjustment reason codes and remittance advice remark codes are standardized code sets maintained by X12. The explanations on this page are written in our own words for educational purposes, based on public CMS and Medicare contractor documentation. Payer policies vary - always confirm handling with the specific payer's guidance and your contracts.