PR-1 — Deductible amount
What it means
The claim was processed, but this portion was applied to the patient's yearly deductible — so the plan paid $0 on it until the deductible is met. This is an adjustment, not a rejection: the service was allowed, the patient just owes it.
Standard definition (paraphrased): The amount applied to the patient's deductible.
Why it happens
- • The patient hasn't met their plan's deductible yet for the benefit year
- • Out-of-network deductibles are often separate from (and higher than) in-network ones
- • The claim was the first one submitted this year
Common next steps therapists take
- • Confirm the patient's OON deductible and how much of it has been met
- • Explain to the patient that this amount counts toward their deductible and is theirs to pay
- • Keep submitting claims — later ones start paying once the deductible is satisfied
Educational information only
This page is general educational information, not legal, billing, or medical advice, and not a determination about any specific claim. Denial codes are maintained by the X12 committee and updated periodically. Always verify code meanings, benefits, and requirements directly with the payer and against your own records.
Fewer denials start with a cleaner claim
Superbilled generates insurance-ready superbills with the correct codes and modifiers, so fewer claims come back with a code like PR-1 to decode.
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