PR-2 at a glance
PR-2 | |
|---|---|
Group code | PR, Patient Responsibility (X12) |
CARC 2 text (X12) | Coinsurance Amount |
In the X12 list since | January 1, 1995 |
What it means for a therapy practice | The plan paid its percentage of the allowed amount and left the rest to the client |
Who owes the PR-2 amount | The client, or a secondary plan if they have one |
Usual action | Bill the secondary payer first if there is one, then the client |
What PR2 means in medical billing
CARC 2 reads "Coinsurance Amount", and the PR group puts it on the patient. Coinsurance is a percentage, unlike a copay, which is a flat fee. So PR‑2 moves with the allowed amount: a longer session with a higher rate produces a larger PR‑2 line, while the client's copay under PR‑3 would stay the same.
PR‑2 usually appears once the deductible is met. Until then, the allowed amount goes to the deductible under PR‑1 and there's no percentage split. On the session that finishes the deductible, you can see both on one line.
How the PR-2 amount is calculated
The formula is the allowed amount times the client's coinsurance rate, after any deductible on that line is taken out. An illustrative family therapy session (90847) for a fictional client whose plan has a 30% coinsurance and whose deductible is already met:
Line item | Amount |
|---|---|
Billed charge | $165.00 |
CO-45 contractual write-off | $45.00 |
Allowed amount | $120.00 |
PR-2 coinsurance, 30% of $120 | $36.00 |
Paid by the plan, 70% of $120 | $84.00 |
Do the multiplication on every remittance for a new plan. If PR‑2 comes to 50% where the client's card says 20%, ask whether the plan processed you as out of network, since many plans set a different coinsurance for out‑of‑network care.
PR-2 for Medicare clients
Under Medicare Part B, the client generally pays 20% of the Medicare‑approved amount for outpatient mental health visits once the Part B deductible is met, according to Medicare.gov's page on outpatient mental health care. That 20% is what arrives as PR‑2 on a Medicare remittance. Using a round $100 approved amount for easy math, Medicare would show $80 paid and $20 under PR‑2.
Many Medicare clients have a supplement or a Medicaid plan that picks up some or all of that 20%. Send the secondary claim before billing the client. If you're tempted to waive the PR‑2 amount as a courtesy, check your payer contracts first and don't make it a routine.
Billing PR-2 to a secondary payer
- Post the primary payment and the PR-2 amount to the line, keeping the CARC and group code as they appear on the remittance.
- Send the secondary claim with the primary payer's adjudication details. Check that your clearinghouse or billing system carries the primary adjustments forward, or the secondary can't work out its share.
- When the secondary remittance comes back, it reports the primary payer's effect with CARC 23, which X12 says to use only with group code OA. Don't read that OA-23 line as a new denial.
- Whatever the secondary leaves under its own PR group is what the client owes.
PR-2 vs PR-1 and PR-3
All three are cost sharing, and all three belong to the client. PR‑1 is the deductible, a fixed dollar amount per plan year. PR‑3 is the copay, a flat fee per visit. PR‑2 is the only one of the three that's a percentage, which makes it the one to check against the allowed amount. The PR-1 page walks through the deductible, and PR-3 covers copays.
Other remittance codes therapy practices see next to PR‑2: CO-45 for the write‑off above the allowed amount, CO-131 for a claim‑specific negotiated discount, and PR-242 when the plan treated you as out of network. If you're working out what a family session or a 60-minute session will cost a client, the 90847 page has the code details.
CPT is a registered trademark of the American Medical Association. CPT codes copyright 2026 American Medical Association. All rights reserved.
Checked against the X12 Claim Adjustment Reason Code list in October 2026. CARC 2 has read "Coinsurance Amount" since January 1, 1995, and it didn't change this year.