1: Deductible Amount
This portion of the charge is being applied to the patient's annual deductible. It is not a denial of the service. The payer is confirming the service is covered but the patient has not yet met their deductible for the benefit period.
What the group code means
- PR
- Patient Responsibility. The amount may be billed to the patient.
Why it fires
- The patient has not met their annual deductible yet
- The visit or service is subject to deductible per the plan design rather than covered at 100 percent
- The deductible resets at the start of a new plan or calendar year and this is an early-year claim
Corrective actions, ranked
- 1
Confirm deductible status
Verify the patient's remaining deductible via the payer portal or EOB to make sure the amount applied is accurate.
- 2
Bill the patient
This amount is standard patient responsibility. Transfer the balance per your normal patient billing workflow.
- 3
Check for deductible waivers
Some preventive or plan-specific services are deductible-exempt. Confirm this service was correctly categorized.
Is it worth appealing
Not an appealable denial. This is a normal cost-share application, though you can dispute it if the service should have been exempt from the deductible under the plan or preventive care rules.
Retrieved 2026-07-18.
Do not let this happen again
Scrub the claim against NCCI PTP and MUE edits before you submit, free and in your browser.
DenialPath provides billing and administrative guidance based on published CMS and X12 sources. It is not medical advice, not a coverage determination, and not a guarantee of payment. NCCI and MUE edits are republished quarterly and payer policies vary by contract. Always confirm against the payer's own current policy before submitting or appealing.