MA13: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code
This is a compliance warning, not a denial by itself. It reminds the provider that only the amount the payer marked with a PR group code can legally be billed to the patient; billing anything beyond that can be a contract or regulatory violation.
Corrective actions
- 1
Review the group codes on the remittance line by line
Confirm exactly which portion of the adjustment carries a PR group code before generating a patient statement.
- 2
Train billing staff on group code rules
Make sure patient statements only reflect PR-coded amounts, and route CO (contractual obligation) or OA (other adjustment) amounts to write-off or appeal instead of patient billing.
Retrieved 2026-07-18.
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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.