PR-3 · CARC
PR-3 — Co-payment amount
What it means
A flat per-visit amount the patient owes under their plan. Common cost-sharing; the service was allowed.
Standard definition (paraphrased): The fixed co-payment owed by the patient.
Why it happens
- • The plan sets a fixed copay per visit
- • Some plans apply a copay even to OON behavioral-health visits
Common next steps therapists take
- • Confirm the plan's copay for outpatient behavioral health
- • Collect or bill the patient the copay as usual
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.
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