PR-2 means the payer paid its share and left the patient's coinsurance, a percentage of the allowed amount, as patient responsibility. You bill the patient or the secondary plan for it.
The official wording
The X12 Claim Adjustment Reason Code list defines 2 as: "Coinsurance Amount"
The letters in front are the group code. CO means contractual obligation (the provider absorbs it), PR means patient responsibility, and OA is other adjustment. The same reason code can come with different group codes, so always read both.
What PR-2 is telling you
Coinsurance is a percentage split. Once the deductible is met, the plan pays its share of the allowed amount, for example 80%, and the patient owes the rest, for example 20%. PR-2 is that patient share.
Traditional Medicare Part B usually leaves 20% of the Medicare-approved amount as coinsurance. Commercial plans vary, so read the amount on each remittance instead of assuming a percentage.
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Common causes
- The normal coinsurance on the patient's plan.
- Out-of-network benefits, which often carry a higher coinsurance.
- A wrong network status on file at the payer, which can make the patient's share look higher than it should be.
How to fix it
- Bill the PR-2 amount shown on the remittance, not a percentage you calculate yourself.
- Send it to the secondary plan first if there is one. Medigap and Medicaid often pay Medicare coinsurance.
- Check network status if the coinsurance looks too high. If you are in network but processed as out of network, ask the payer to reprocess.
- Bill the patient for what is left after any secondary payment.
How to prevent it
- Verify each patient's coinsurance and secondary coverage at every visit.
- Keep your contracts and network status current with every payer.
- Use the payer's cost estimator, or your own fee schedule, to tell patients their share up front.
One claim, line by line
A patient has met their deductible. Their plan pays 80% and they pay 20%. The visit has a $200 charge and a $140 allowed amount.
| Line on the remittance | Amount | How it was worked out |
|---|---|---|
| Billed charge | $200.00 | Your charge |
| CO-45 | $60.00 | $200 billed minus $140 allowed. Write off. |
| PR-2 | $28.00 | 20% of the $140 allowed amount |
| Paid by payer | $112.00 | 80% of the $140 allowed amount |
Check: $112 paid + $28 PR-2 = $140 allowed. The patient owes $28, not 20% of your $200 charge.
Who pays PR-2 when there is a second plan
| Second plan | Does it usually pay the PR-2? |
|---|---|
| Medigap (Medicare supplement) | Yes, most Medigap plans pay the Part B coinsurance |
| Medicaid as secondary to Medicare | Often yes, up to the Medicaid rate |
| Commercial plan as secondary | Often yes, under its own coordination rules |
| No second plan | No. Bill the patient. |
Always send the claim to the second plan with the primary EOB before you bill the patient.
When PR-2 looks too high
- Processed as out of network. Out-of-network coinsurance is often 40% or more. If you are in network, ask the payer to reprocess.
- Deductible counted as coinsurance. Add up PR-1, PR-2 and PR-3. They should equal the allowed amount minus the payment.
- Wrong allowed amount. If the allowed amount is too low, the CO-45 is hiding an underpayment. See our CO-45 guide.
How to post PR-2
- Post the payer payment.
- Post CO-45 as a contractual adjustment.
- Move the PR-2 amount to the secondary payer if there is one.
- Bill the patient only what is left after the secondary pays.
- Note any coinsurance collected at the visit so the patient is not billed twice.
PR-2 checklist
- ☐ The PR-2 amount matches the plan's coinsurance on the allowed amount.
- ☐ The claim was processed in network.
- ☐ A secondary plan has been billed if the patient has one.
- ☐ The patient is billed only the PR amounts.
Questions people ask about PR-2
Is PR-2 a denial?
No. It is the patient's coinsurance share of a claim the payer processed and paid in part.
Can I bill the patient for PR-2?
Yes, the amount shown with PR-2. If the patient has secondary coverage, bill that plan first.
What is the difference between PR-1, PR-2 and PR-3?
PR-1 is the deductible, PR-2 is coinsurance (a percentage), and PR-3 is a copay (a fixed amount). All three are patient responsibility.
How is PR-2 calculated?
It is a percentage of the allowed amount, not your charge. If the allowed amount is $140 and coinsurance is 20%, PR-2 is $28.
Does Medigap pay PR-2?
Most Medigap plans pay the Medicare Part B coinsurance. Send the claim to the Medigap plan, or check that Medicare crossed it over, before billing the patient.
Why is the coinsurance higher than usual?
The claim may have processed out of network, where the patient share is higher. If you are in network, ask the payer to reprocess.
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PR-1 · PR-2 · PR-3 · CO-4 · CO-5 · CO-11 · CO-15 · CO-16 · OA-18 · CO-22 · OA-23 · CO-24 · CO-26 · CO-27 · CO-29 · CO-31 · CO-45 · CO-49 · CO-50 · CO-59 · PR-96 · CO-97 · CO-109 · CO-119 · CO-129 · CO-140 · CO-146 · CO-151 · CO-167 · CO-170 · CO-181 · CO-185 · CO-197 · CO-198 · PR-204 · CO-234 · CO-236 · CO-242 · CO-252 · CO-253 · CO-288 · CO-A1 · CO-B7 · MA130 · N130 · N23 · N290
Timely filing limits by payer: Cigna timely filing limit · HealthSpring timely filing limit · Aetna timely filing limit · UnitedHealthcare timely filing limit · Humana timely filing limit · corrected claim timely filing limits
Sources: X12 Claim Adjustment Reason Code list (2), read October 26, 2026; CMS Medicare guidance where Medicare rules are mentioned; Patient share example uses a standard 80/20 plan for illustration only. Last reviewed October 27, 2026. General information, not coding or legal advice. Payer rules differ, so check the remark code and the payer's own policy.