PR-2 — Coinsurance amount
What it means
The plan allowed the service and paid its share; this is the percentage the patient owes (e.g. 20-40% of the allowed amount) after the deductible. Normal cost-sharing, not a denial.
Standard definition (paraphrased): The patient's coinsurance share of the allowed amount.
Why it happens
- • The plan pays a percentage of the allowed amount and the rest is the member's coinsurance
- • OON coinsurance percentages are usually higher than in-network
Common next steps therapists take
- • Confirm the plan's OON coinsurance percentage
- • Let the patient know this share is expected and theirs to pay
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-2 to decode.
Get started free