Denial code PR-1: deductible amount
Also printed as 1
PR-1 means: Your deductible. This part is yours to pay until the deductible is met. This is an adjustment, not a denial. Can they bill you for it? Yes. PR means the plan says this amount is yours, unless the decision changes.
Who usually fixes it
Nobody: it is an adjustment, not a denial.
What PR-1 means
Your deductible. This part is yours to pay until the deductible is met.
How CO, PR, OA and PI change it
1 is almost always printed with the group code PR, which says who the plan thinks owes the amount.
| Code | Can the provider bill you? |
|---|---|
| PR-1 Patient responsibility | Yes. PR means the plan says this amount is yours, unless the decision changes. |
Appeal rights by plan type
If you think the amount is wrong, ask the plan to explain it. Your appeal rights and deadlines depend on your plan:
- Most private plans
- Marketplace and individual plans
- Job-based plans
- Fully insured job-based plans
- Self-funded job-based plans (ERISA)
- Original Medicare
- Medicare Advantage
- Medicare Part D drug plans
- Medicaid and CHIP
Quick answers
- What does denial code PR-1 mean?
- Your deductible. This part is yours to pay until the deductible is met. This is an adjustment, not a denial.
- Can the provider bill me for PR-1?
- Yes. PR means the plan says this amount is yours, unless the decision changes.
- Who fixes PR-1?
- Nobody: it is an adjustment, not a denial. This is an adjustment, not a denial.
Codes are from the national X12 lists, in plain words. Your notice and your plan are the final word on why a claim was denied. General information, not legal advice.
Sources
- https://x12.org/codes/claim-adjustment-reason-codes
- https://x12.org/codes/remittance-advice-remark-codes
Ask Appeal My Claim yourself
Type any code from your Explanation of Benefits, like CO-50, PR 204 or N130, and get it in plain words, with a letter when an appeal fits. Open Appeal My Claim, free, no sign-up.
In Claude or any app that takes MCP connectors, add https://goodturn-mcp.pages.dev/appealmyclaim/mcp and ask: “My EOB says PR-1, what does that mean?”